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RC734  .L52  1884    A  pharmacopoeia  for 


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A 

PHARMACOPOEIA 


FOR   THE    TREATMENT    OF 


DISEASES    OF   THE    LARYNX,    PHARYNX 

AND 

NASAL  PASSAGES 


With  Remarks  on  the  Selection  of  Remedies  and  Choice  of 

Instruments  and   on  the  Methods   of   Making 

Local  Applications 


BY 


GEORGE    MOREWOOD    LEFFERTS,  A.M.,  M.D. 

Clinical  Professor  of  Laryngoscopy  and  Diseases  of  the  Throat,  CoUes^e  of 
Physicians  and  Surgeon's,  Medical  Department  of  Columbia  College 

New  York 


SECOND  EDITION,  REVISED  AND  ENLARGED 


NEW  YORK  &  LONDON 

G.    P.    PUTNAM'S    SONS 

Vi^z  ^nitkcibotkr  ^rcss 

1884 


COPYRIGHT    BY 

GEORGE  MOREWOOD  LEFFERTS 


Press  of 
P.  Putnam's  Sons 
New  York 


PREFACE. 


The  experience  of  a  number  of  years  in  clinical  teacli- 
ing  has  convinced  me  that  the  time  which  is  ordinarily 
devoted,  during  a  limited  course  of  lectures  on  a  special 
subject,  in  dictating  to  the  student  in  the  first  instance, 
and  repeating  in  detail  from  time  to  time  during  the 
course,  the  necessarily  large  number  and  variety  of 
formulae  that  are  requisite  for  intelligent  treatment,  can 
be  more  profitably  employed,  and  the  subject  itself  bet- 
ter and  more  clearly  understood  without  laborious  and  too 
often  imperfect  note-taking,  by  collecting  the  commoner 
and  more  reliable  ones  in  a  systematic  but  simple  form, 
which  will  always  be  accessible  and  ready  for  reference. 

In  pursuance  of  this  conviction  I  have  prepared  this 
little  volume  for  the  use  of  my  Students,  and  in  connection 
with  my  lectures,  and  I  offer  this  explanation  to  those 
members  of  the  profession  who  may  have  occasion  to 
consult  my  work,  in  view  of  the  necessarily  somewhat  brief, 
even  dogmatic,  manner  in  which  certain  personal  views 
are  presented  and  certain  courses  of  treatment  advised. 

The  following  pages  will  be  found  to  contain  the  for- 
mulae alone  of  such  local  applications  as  are  adapted  to 
the  treatment  of  the  various  affections  of  the  larynx,  phar- 
ynx, and  nasal  passages,  and  which  have  been  carefully 
tested  in  the  light  of  personal  clinical  experience  and 
found  to  possess  a  practical  worth. 


IV  PREFACE. 

Constitutional  remedies  are  not  included  in  the  list, 
being  foreign  to  the  purpose  of  the  work,  but  they  are 
none  the  less  regarded  as  of  the  highest  importance  in  the 
treatment  of  many  of  the  affections  with  which  it  deals. 

The  formulae  have  been  collected  from  various  works 
and  authorities  ;  many  of  them  are  original.  I  have 
availed  myself  of  the  labors  of  my  predecessors  and  con- 
temporaries whenever  it  has  been  possible,  and  here  ren- 
der them  my  general  acknowledgment,  specific  credit  in 
all  instances  to  the  sources  of  information  being  imprac- 
ticable in  a  work  of  this  character  and  size. 

Many  drugs  and  combinations  that  have  been  recom- 
mended from  time  to  time  in  the  rapid  development  of 
the  speciality  have  been  rejected  as  having  no  real  value, 
but  none  that  are'to-day  regarded  as  essential  have,  it  is 
believed,  been  omitted. 

I  have  thought  it  desirable,  in  the  present  new  edition, 
to  add  certain  suggestions  which  will  serve  as  a  guide  to 
the  student  in  his  choice  of  remedies,  and  remarks  on 
the  proper  method  of  making  applications  to  the  various 
parts,  together  with  illustrations  of  the  requisite  apparatus, 
all  with  the  view  of  rendering  the  entire  matter  of  local 
treatment  clear  and  readily  understood. 

All  matters  relating  to  practical  Pharmacy  have  been 
kindly  revised  for  me  by  George  D.  Hays,  M.D.,  Ph.G. 

If  the  little  volume  now  presented  to  the  medical  class 
will  aid  in  systematizing  and  simplifying  the  labors  of 
its  students  in  this  department  of  therapeutics,  its  mission 
will  have  been  fulfilled. 

G.  M.  L. 

October,  1884. 


CONTENTS. 


I.      Pigmenta    ........ 

A. — For  External  Use 

B. — For  Internal  Use  (Nasal  Passages.) 

II.  Collunaria — Cleansing  and  Disinfecting  Solutions 

III.  Aquae  Medicatse — Medicated  Sprays    . 

IV.  Collyria — Medicinal  Solutions  for  Local  Application 

V.  Pulveres — Powders  for  Insufflation 

VI.  Buginaria — Nasal  Bougies  ..... 

VII.  Gossypia — Medicated  Cotton-Wools    . 

VIII.     Inhalationes — Inhalations   ..... 
A. — ^Vapores  Calidi — Steam  Inhalations. 
B. — Nebulae — Atomized  Fluid  Inhalations. 
C. — Fumi — Fumincr  Inhalations. 


3 

12 

25 
29 

36 

39 
40 


IX. 

Gargarismas — Gargles 

.         .         56 

X. 

Trochisci — Lozenges— Pastils 

61 

XI. 

Caustica — Caustics      .... 

68 

XII. 

Varise — Miscellaneous 

79 

Appendix  ...... 

82 

Classified  Index.         .... 

.         .         91 

PIGMENTA. 
A.  For  External  Use. 

Employed  in  some  forms  of  Laryngitis,  as  counter-irritants.     Ap- 
plied externally  over  the  larynx. 

Ceratum  Cantharidis. 

Charta  Cantharidis. 

Linimentum  Cantharidis. 

Tinctura  lodi. 

Tinctura  lodinii  Composita  (U.S. P.,  1870). 

Linimentum  lodi  (B.P.). 

Used  as  anesthetics,  in  the  forms  of  Hyperaesthesia  of  the  Larynx. 
Applied  externally  over  the  organ. 

Ungaentum  Aconitiae  (B.P.). 
Linimentum  Aconiti  (U.S. P.,  1870). 
Linimentum  Belladonnae. 
Linimentum  Chloroformi. 

Pulveris  Camphorse. 

Chloralis    .         .         .         .      aa      f  ss 

Rub  together  in   a  warm  mortar  until  liquefied,  then 
filter. 

Signa — Camphorated  chloral. 


PHA  RMA  COP  CEIA , 


B.  For  Internal  Use. 


Used  as  applications  to  the  nasal  passages,  by  means  of  a  camel's- 
hair  pencil  or  brush. 


Fig.  I. — Brushes  for  applications  to  the  nasal  passages. 


Petrolati  (Vaseline) 

Petrolati 

Hydragyri  Chloridi  Mitis 
M.  Ft.  unguentum. 


^ 


Unguenti  Belladonnae    . 


q.  s. 


3  ss 
3  ss 


q.  s. 


^ 


Acidi  Carbolici       .         .         .  gr.  ii 

lodi gr.  ii 

Atropinse        .         .         .         .  gr.  ss 

Petrolati          .          .          .ad  3  i 

M.  Ft.  unguentum.      Signa — In  Chronic  Rhinitis, 


11. 


COLLUNARIA— CLEANSING   AND    DISIN- 
FECTING  SOLUTIONS. 


Solutions  for  general  cleansing  purposes,  used  in  coarse  spray  in 
the  larynx  and  nasal  passages,  or  by  means  of  the  anterior  and  pos- 
terior nasal  syringe,  to  the  latter  region,  at  a  temperature  of  about 
90°-ioo°  F. 

LarynXo 

Careful  cleansing  of  the  mucous  surfaces  of  the  larynx 
is  not  infrequently  a  necessary  procedure,  prior  to  the 
application  of  the  medicated  spray  or  powder.  Notably 
is  this  the  case  in  Laryngeal  Phthisis,  where  the  secre- 
tions are  thick,  abundant,  and  tenacious,  and  thus  mask 
the  diseased  parts — specially  the  ulcerations,  which  lie 
beneath  them.  The  cleansing  process  is  best  performed 
by  means  of  the  laryngeal  spray,  used  with  compressed 
air  (see  page  13),  and  one  or  two  applications  are  to  be 
made,  either  with  or  without  the  aid  of  the  laryngoscopic 
mirror,  at  each  sitting,  before  use  of  the  medicament. 
The  following  solution  may  be  used  * 

3 


4  F HARM  A  COP  (EI A . 

Sodii  Bicarbonatis. 

Sodii  Boratis          .         .         .  aa  3  ss 

Listenne                ...  31 

Aquae     .         .         .         .ad  |  iv 

Nasal  Passages. 

A  very  essential  principle  in  the  local  treatment  of 
catarrhal  affections  of  the  nasal  passages  is  thorough 
cleanliness  ;  it  underlies  all  others.  There  certainly  can 
be  little  remedial  value  in  the  application  of  a  medicated 
spray  or  powder  that  only  reaches  parts  covered  and  pro- 
tected by  a  layer  of  thick,  tenacious  mucus,  or,  still  less, 
those  encased  in  an  armor  of  hard,  inspissated  crusts. 
On  the  other  hand,  I  am  convinced  that  this  matter  of 
cleanliness,  if  the  latter  be  understood  to  mean  frequent, 
daily,  even  several  times  a  day,  syringing  of  the  nose,  is 
overdone,  and  that  it  does  much  harm.  The  comfort, 
fancied  or  real,  that  the  patient  experiences  after  the  use 
of  his  ''nasal  douche,"  even  though  this  relief  be  only 
temporary,  as  it  always  is,  leads  him  to  repeat  the  process 
with  constantly  increasing  frequency.  Instances  are  not 
unknown  where  patients  will  use  a  quart  of  strong  saline 
solution,  under  higli  pressure,  through  the  nose  several 
times  daily.  Physicians  are  not  entirely  guiltless  in  the 
matter,  for  it  is  not  infrequently  that  the  patient  is  mis- 
led by  their  belief  that  the  cure  of  a  nasal  catarrh  lies  in 
the  use  of  a  "  douche."  Such  practices,  I  repeat,  are 
productive  of  no  good,  but  much  harm.      Even  apparent 

*  See  page  23. 


COLLUNAKIA.  5 

temporary  good  effects  ultimately  fail.  The  use  of  strong 
saline  solutions  in  large  quantity,  passed  through  the 
nares  under  high  pressure,  is  not  infrequently  an  efficient 
factor  in  the  propagation,  if  not  in  the  causation,  as  I  be- 
lieve that  I  have  many  times  seen  it,  of  a  chronic  inflam- 
mation of  the  delicate  nasal  mucous  membrane,  with  its 
usual  result  of  permanent  infiltration  of  the  mucous  and 
submucous  structures.  All  this  rather  than  a  means  for 
its  relief. 

While,  then,  cleanliness  is  essential,  mechanical  means 
for  attaining  it  are  to  be  used  with  great  discretion. 
There  is  nothing  curative  in  their  employment.  They 
are  by  no  means  as  generally  necessary  as  was  formerly 
supposed.  I  believe  that  in  my  practice  I  have  discon- 
tinued their  use  in  more  than  fifty  per  cent,  of  cases,  and 
the  latter  not  only  do  just  as  well,  but  better,  being 
relieved  of  an  element  of  irritation.  All  instruments,  then, 
for  cleansing  purposes,  and  I  include  here  the  "nasal 
douche  "  with  its  many  modifications,  anterior  and  pos- 
terior nasal  syringes,  and  the  like — I  even  add  cleansing 
sprays — are  only  necessary  and  are  only  to  be  used  in 
exceptional  cases  of  aggravated  catarrhal  inflammation, 
with  accumulation  of  pent-up  or  hardened  secretions, 
and  in  cases  attended  by  the  formation  and  firm  impac- 
tion in  the  passages  of  hard,  dense  crusts,  as  in  atrophic 
or  fetid  catarrh  and  in  ozaena.  In  simple  chronic  rhini- 
tis, and  in  some — perhaps  one  half — of  the  cases  of 
hypertrophic  rhinitis  their  use  is  not  required  as  a  rule. 
The  patient  can  readily  remove  the  soft,  semi-fluid  secre- 
tions by  simply  blowing  the  nose  ;  if  he  cannot,  or  if  the 
secretions  collect  at  the  vault  of  the  pharynx,  one  jet  of 


PHARMA  COP  mi  A . 


spray  containing  some  alkali  or  some  ''  Listerine," 
thrown  behind  the  velum  or  into  the  anterior  nares,  just 
prior  to  the  use  of  the  medicated  spray  or  powder  will  be 
amply  sufficient  to  loosen  and  remove  them. 

Let  us  suppose,  however,  that  we  are  called  upon  to 
treat  a  case  such  as  I  have  described,  where  the  use  of 
some  instrument  is  a  necessity  in  order  that  the  pent-up 
or  hardened  secretions  may  be  removed  before  you  make 
your  application  of  the  remedial  agent.  What  form  of 
instrument  shall  we  use  ?  Which  method  prefer  ?  Never 
use  a  "  nasal  douche,"  it  is  an  inefficient  instrument  for 
the  purpose  for  which  it  was  designed,  insomuch  as  it 
does  not  thoroughly  wash  or  cleanse  the  nasal  cavities, 
even  when  carefully  used.  I  prefer,  and  I  strongly 
advise  the  employment  of  the  instrument  that  I  show 


Fig.  2. — Nasal  spray  apparatus. 

here,  and  which  I  devised  some  years  ago.  It  is  simply  an 
apparatus  arranged  to  throw  a  very  coarse  spray  in  the 
right  direction  into  the  anterior  nares.  The  conical  tip 
closes  one  nostril  completely;   the  fluid  then  enters  one 


COLLUNARIA.  y 

nasal  passage  and  passes  out  by  the  other.  Power  is 
obtained  by  means  of  a  double  hand-ball  tube.  We  call 
it  the  "nasal  spray  apparatus."  With  it  the  nasal  passa- 
ges and  upper  pharynx  may,  except  in  rare  instances,  be 
thoroughly  cleansed  of  secretions  and  crusts  by  the  use 
of  less  than  one  ounce  of  the  medicated  fluid  contained 
in  its  bottle  or  reservoir.  Here,  at  once,  is  an  immense 
advantage  gained  over  the  quart  or  even  pint  of  fluid 
used  commonly  in  the  "  douche."  Being  a  coarse  spray 
it  washes  up,  loosens,  and  dislodges  the  secretions  (unless 
they  are  firmly  impacted  in  extreme  cases)  by  the  con- 
stant commotion  of  the  fluid  in  the  nasal  passages,  and 
this  very  readily  and  quickly.  Explicit  directions  are  to 
be  given  in  every  case  to  the  patient  for  its  use.  They 
are  as  follows  : 

1.  Warm  the  medicated  fluid  in  the  bottle  before  using, 
by  holding  the  filled  bottle  for  a  few  moments  in  hot 
water. 

2.  Hold  the  body  erect  and  incline  the  head  very 
slightly  forward  over  the  toilet  basin. 

3.  Introduce  the  conical  nozzle  of  the  apparatus  into 
the  nostril  (first  on  the  side  most  occluded)  far  enough  to 
close  it  perfectly,  holding  at  the  same  time  the  horizontal' 
tube  of  the  apparatus  directly  outwards  from  the  face  ; 
do  not  turn  it  from  side  to  side  or  downward,  and  make 
a  trial  of  the  spray  by  compressing  the  hand  ball  once,  to 
prove  that  the  opening  in  the  nozzle  is  not  occluded  in 
the  nostril ;  then — 

4.  Open  the  mouth  widely  and  breathe  gently  but 
quickly  through  it  in  a  snoring  manner  ;  avoid  carefully 
all  attempts  at  speaking,  swallowing,  or  coughing  (at  the 


8  PHARMACOPCEIA. 

moment  that  the  fluid  passes  into  the  upper  part  of  the 
throat  from  the  nostril  being  operated  upon,  a  desire  to 
swallow  will  be  experienced;  resist  it,  and  the  next 
second  the  fluid  passes  forward  through  the  opposite 
nostril). 

5.  Hold  the  end  ball  of  the  apparatus  firmly  in  the 
right  hand  (the  left  holds  the  bottle)  and  operate  it  briskly^ 
until  the  spray  of  medicated  fluid,  which  should  be  felt  at 
once  to  enter  the  nasal  passage,  has  passed  around  it  and 
appears  at  the  opposite  nostril;  at  this  moment,  stop. 

6.  Remove  the  nozzle  from  the  nostril;  allow  the  sur- 
plus fluid  to  run  out  of  the  latter  ;  then  blow  the  nose 
gently — 7iever  vigorously. 

7.  Repeat  the  operation  upon  the  opposite  nostril. 

In  the  severer  forms  of  nasal  disease — those  attended 
by  the  formation  and  impaction  of  hard,  dense  crusts 
and  masses  in  the  nasal  passages  and  upper  pharynx — 
the  use  of  this  "  nasal  spray  apparatus "  will  not  be 
sufficient  to  dislodge  them  in  the  first  instance,  and 
a  more  powerful  means  (short  of  direct  instrumental 
removal)  must  be  employed.  This  result  is  obtained 
by  the  ''posterior  nasal  syringe,"  of  hard  rubber  or 
metal,  with  a  long,  curved  nozzle,  which  is  used  to  cleanse 
the  parts  posteriorly  (by  way  of  the  upper  pharynx  and 
posterior  nares). 


Fig.  3. — Posterior  nasal  syringe. 


COLLUNARIA.  9 

Or  still  better,  by  means  of  the  apparatus  figured  below. 


Fig  4. — Post-nasal  tube  with  metal  syringe. 

This  procedure  is  always  disagreeable,  sometimes  pain- 
ful, to  the  patient,  and  care  must  always  be  taken  not  to 
bruise  the  parts  during  the  introduction  of  the  nozzle  of 
the  syringe  or  tube.  Toleration  will  be  established  after 
a  time.  For  cleansing  purposes  through  the  anterior  nares 
an  easier  matter — the  large,  hard-rubber  syringe  of  the 
aurist  answers  the  purpose  well. 


Fig.  5. — Anterior  nasal  syringe. 


Cleansing  and  Disinfecting  Solutions. 

]^ 

Sodii  Bicarbonatis. 

Sodii  Boratis  .         .         aa       3  ss 

"Listerine"    .         .         .         .  §i 

Aquae  .         .         .ad  ^  iv 

M.     Signa — Used  with  the  nasal  spray  apparatus. 


lO  PHARMACOPCEIA, 

Acidi  Carbolici            .  .         gr.  v-x 

Sodii  Boratis. 

Sodii  Bicarbonatis       .  .     aa      3  ss 

Glycerini. 

Aquae  Rosae        .         .  .     aa      3  ii 

Aquae          ...  ad          3  iv 

M.     Signa — Used  with  the  nasal  spray  apparatus. 

"  Listerine  "     .  3  ss,   3  i,   3  ii,   %  iv 

Aquae       .....         f  iv 

M.     Signa — Used  with  the  nasal  spray  apparatus. 

Where  a  much  larger  quantity  of  a  cleansing  solution 
is  necessarily  used,  as  with  the  anterior  or  posterior  nasal 
syringe,  simple  warm  water,  with  the  addition  of  borax — 
ten  grains  to  each  ounce — or  "  Listerine  "  in  the  propor- 
tion of  one  part  to  from  two  to  ten  of  warm  water,  will 
answer  the  purpose.  I  sometimes — when  the  disagree- 
able odor  is  strong — use,  after  a  thorough  syringing  with 
an  alkaline  solution,  2,  spray  of  equal  parts  of  "  Listerine  " 
and  water  ;  it  destroys  fetor  very  quickly,  and  substitutes 
for  it  the  pleasant  odor  of  the  thyme.  Other  cleansing 
solutions  for  use  in  large  quantity,  with  the  syringe,  are 
as  follows.  They  should  all  be  used  at  or  near  the 
temperature  of  100°  F. 

Glyceriti  Acidi  Carbolici  (U.S. P.  1870)  3  jss 

Sodii  Boratis  .         .         .         .         .  3  i 

Aqus ad  Oi 

M. 


COLLUNARIA.  \i 

Liquoris  Potassii  Permanganatis  (U.S. P.  1870)  3  iss 

Sodii  Boratis     .         .         .         .         .         .         .  3  i 

Aquse         . ad  O  i 

M. 


^ 

Acidi  Salicylici 

.       gr.  X 

Sodii  Bicarbonatis    . 

3i 

Aquae        .... 

Oi 

M. 

5 

Sodii  Bicarbonatis. 

Sodii  Boratis. 

Sodii  Chloridi         .         .        aa     gr.  vii 

Sacchari  .         .         .         .       gr.  xv 

M.  Signa — The  powder  should  be  dissolved  in  about  half  a 
tumblerful  of  tepid  water. 

Sodii  Boratis 3i 

Glyceriti  Acidi  Carbolici  (U.S.P.  1870)     .  3  ii 

Sodii  Bicarbonatis     .         .         .         .         .  3  i 

Aquae        ....                  .         .  O  ss 

M.     Signa— "  Dobell's  Solution." 

The  water  should  be  warm.  Chlorate  of  potash  or 
"  Condy's  fluid  "  solution  of  permanganate  of  potassium 
may  be  used  in  place  of  the  Borax  in  this  formula. 


in. 


AQIJJE      MEDICATiE  —  MEDICATED 
SPRAYS. 

Solutions  for  local  applications,  by  means  of  glass,  hard-nibber, 
or  metal  spray  tubes  and  the  compressed  air-apparatus,  or  by  any  of 
the  many  forms  of  hand-ball  atomizer,  adapted  for  the  purpose,  to 
the  larynx,  pharynx,  anterior  and  posterior  nares. 

My  own  experience  prejudices  me  strongly  in  favor  of 
the  medicated  spray,  as  a  means  of  making  a  thorough 
and  efficient  application  to  a  diseased  laryngeal  mucous 
membrane.  In  regard  to  its  superiority  over  other 
methods  in  applications  to  the  upper  pharyngeal  space 
and  posterior  nares,  as  well  as  anteriorly,  through  the 
nasal  passages,  there  is,  I  think,  no  question.  I  believe, 
that  with  a  proper  spray  tube  and  a  pressure  of  com- 
pressed air  of  about  forty  pounds  to  the  square  inch,  no 
more  perfect  application  can  be  made  to  the  parts.  I 
prefer  this  high  pressure  of  compressed  air  to  the  lower 
power  so  often  recommended.  I  have  never  done  harm 
to  the  mucous  membrane  with  it,  and  the  increased  power 
of  propulsion  in  the  cloud  of  spray,  renders  it  possible  to 
reach  instantly — before  any  spasmodic  contraction  of  the 
larynx   takes  place — its   entire   mucous  surface.     In  the 

12 


AQUM  MEDIC  A  Tj^.  T^ 

nasal  passages  the  same  pressure  causes  the  spray  to  en- 
ter and  thoroughly  bathe  all  of  the  many  irregularities  and 
recesses  that  here  abound- 

Larynx. 

A  spray  application  to  the  larynx  should  always  be 
made,  as  is  that  with  the  laryngeal  brush  (see  remarks  : 
Collyria),  under  the  guidance  afforded  by  the  laryngo- 
scopic  mirror — the  concave  forehead  mirror  and  artificial 
illumination  being  used,  the  patient  holding  his  own 
tongue  and  phonating  the  vowel  sound  "  e,"  in  order 
to  elevate  the  epiglottis  and  bring  the  vocal  cords  to- 
gether at  the  instant  before  the  volume  of  spray  is  dis- 
charged into  the  larynx  ;  the  operator  holds  the  spray 
tube  in  his  right  hand,  and  the  laryngoscopic  mirror  in 
his  left. 

Pharynx. 

A  spray  application  to  the  middle  pharynx  is  made  at 
the  moment  that  the  operator,  with  his  left  hand  holding 
the  spatula,  depresses  the  patient's  tongue  well  down 
into  the  floor  of  the  mouth,  and  while  the  latter  is  breath- 
ing quietly,  in  order  that  the  parts — viz.,  the  faucial  pillars, 
soft  palate,  and  constrictor  muscles  of  the  pharynx — may 
be  relaxed,  not  contracted.  A  much  larger  space  is  thus 
uncovered  to  the  spray,  and  a  corresponding  degree  of 
effectiveness  gained. 

Nasal  Passages. 

A  spray  to  the  nasal  passages  should  always  be 
applied,    if    possible,    through  the  upper   pharynx  and 


14 


P  HARM  A  COPCEIA. 


posterior  nares,  as  follows  :  The  patient  depressing  his 
tongue  by  means  of  a  spatula,  the  velum  palati  must  be 
drawn  forward — that  is,  away  from  the  posterior  pharyn- 
geal wall — by  means  of  a  suitable  strong  wire,  bent  at  its 
end  into  a  small,  rounded  hook  and  covered  by  bougie 
material — a  procedure  that  can  readily  be  accomplished 
in  all  cases  after  a  little  practice,  and  one  that  I  regard  as 
absolutely  essential  to  the  thorough  success  of  the  appli- 


FlG.  6. — Compressed-air  spray  apparatus.* 

cation,  as  it  is  the  only  way  in  which  a  practicable  degree  of 
space  can  be  gained  through  w'hich  to  throw  a  spray  up- 
ward and  forward  through  the  nasal  passages.  To  at- 
tempt an  application  w^ith  the  velum  drawn  upward  and 
backward — closely  approximated  to  the  pharyngeal  wall, 
is  nonsense  ;  in  this  position  it  will  be  found,  the  moment 

*  The  complete  compressed-air  spray   apparatus  is  manufactured 
by  J.  Reynders  &  Co.,  of  New  York. 


AQUM  MEDICATE. 


15 


that    you    introduce  your  spray   tube  into   the   patient's 
mouth,  in  nine  cases  out  of  ten. 

The  ''palate  hook  "  is  held  in  the  operator's  left  hand, 
his  right  holds  and  controls  the  spray  tube  and  the  spray 
(the  tube,  being  passed  back  of  the  velum,)  is  thus  thrown 
upwards   into   the   vault   of   the  pharynx  and  forwards 


Fig.  7. — Compressed-air  spray  apparatus. 

through  both  nasal  passages,  so  that  it  appears,  at  both 
nostrils,  in  a  fine  cloud. 

Such  applications  as  are  here  described  are  thorough 
and  complete,  not  painful  nor  even  very  disagreeable  to 
the  patient,  and  that  the  results,  obtained  by  a  series  of 
such,  far  exceed  those  obtained  by  any  other  method  of 
local  applications,  ample  experience  has  shown  me. 


l6  PH ARM  A  COP  (EI A. 

The  spray  tubes  shown  in  fig.  8  are  made  of  vulcanized 
rubber ;  the  best  and  cheapest  tubes,  however,  are  those 
made  of  glass,  but  they  are,  of  course,  more  fragile  than 
the  above,  or  than  the  others  made  of  metal  and  nickel- 
plated,  which  can  only  be  used  with  certain  non-corrosive 
solutions.  A  spray  tube  has  been  designed  by  Wile, 
that  is  modelled  after  the  pattern  of  Sass,  but,  instead  of 
being  made  of  two  tubes  cemented  together,  as  in  the 
case  of  glass,  or  riveted,  as  in  the  ordinary  hard-rubber 
tubes,  both  of  which  are  liable  to  break  or  spring  apart, 
the  tubes  in  question  are  made  of  one  solid  piece  of  hard 
rubber  ;  and  the  tips,  instead  of  being  permanently  at- 
tached to  the  body  of  the  tubes,  are  screwed  in  and  are 
made  interchangeable.  By  means  of  a  small  wrench, 
they  are  readily  unscrewed  and  taken  out  for  purposes  of 
cleansing. 

The  "  automatic  cut-off,"  for  attachment  to  the  end  of 
the  spray  tube  for  the  purpose  of  controlling  the-  air 
current  (fig.  9),  is  preferred  by  some  operators.  A 
cheaper  and,  I  think,  a  better  method,  is  to  attach  the 
spray  tube  to  the  connecting  rubber  tube  (covered  with 
silk  or  mohair) — (see  fig.  6  and  fig.  7)  from  the  air 
receiver,  by  means  of  a  metal,  air-tight  bayonet  joint,  and 
then  control  the  air  current  through  the  rubber  tube,  by 
pressure  of  this  with  the  thumb  of  the  hand  that  holds 
the  spray  tube  against  the  end  of  the  latter  (see  fig.  6)  ; 
or,  if  necessary — but  it  is  less  convenient — the  connect- 
ing rubber  tube  from  the  air  receiver  may  be  simply 
slipped  over  the  end  of  the  spray  tube  at  the  time  the 
application  is  made  to  the  throat  with  the  latter,  and  the 
air-current  controlled  by  the  thumb,  as  above  described. 


AQU^E   MEDICATE. 


17 


Three  spray  tubes  constitute  a  set.  One  is  so  arranged 
as  to  throw  the  jet  of  spray  upwards  (naso-pharynx)  ;  the 
second,  downwards,  (larynx)  ;  and  the  third,  directly  out- 
wards (pharynx  and  anterior  nasal  passages). 


Fig.  8. — Hard-rubber  spray  tubes.         Fig.  9, — Automatic  cut-off,  for 

spray  tube. 

If  the  general  practitioner  has  not,  or  cannot  obtain, 
the  above  instruments — viz.,  the  compressed-air  ap- 
paratus with  air-pump  and  spray  tubes — he  is  necessarily 
obliged  to  depend  upon  some  form  of  hand  atomizer, 
constructed  upon  either  the  principle  of  Richardson  or 
Bergson,  and  in  which  the  propelling  power  is  developed 
by  the  use  of  hand-ball  bulbs  and  tubes.  Of  these 
atomizers  there  is  a  great  variety  ;  they  are  sold  every- 
where, and  at  a  moderate  cost.  A  very  good  one  is  manu- 
factured by  the  Davidson  Rubber  Co.,  and  called  Hard- 
rubber  Atomizer,  Continuous  Spray,  No.  61,  Others  are 
shown  in  the  following  figures.  Codman  &  Shurtleff,  of 
Boston,  manufacture  likewise  a  large  variety  of  very 
useful     and      efficient     forms    of    hand-ball     atomizer. 


1 8  PHARMACOPCEIA. 

There  is,  then,  no  difficulty  in  securing  a  proper  ap- 
paratus, and,  by  means  of  such,  an  application 
can  be  made  with  care,  with  good  effect,  rarely,  how- 
ever, with  the  efficiency  that  attends  the  use  of  the 
compressed-air  apparatus.  In  any  of  these  forms  of 
atomizer,  the  hand-balls  should  be  double,  in  order 
that  a  continuous  spray  may  be  produced,  and  each 
instrument  must  be  provided  with  three  separate  tips 
(occasionally  only  two  are  furnished,  one  of  which 
is  reversible),  which   screw  or  fasten    on  the  horizontal 


Fig.  10. — Hard-iTibber  atomizer,        Fig.  ii. — Hard-rubber  atomizer, 
continuous    spray    (with    two  continuous  spray   (with  three 

tips).  tips). 

hard-rubber  bar  of  the  spray  tube  (one  throws  the  spray 
downward  to  the  larynx,  one  upward  into  thenaso-pharynx, 
and  the  third  directly  backward  into  the  pharynx). 

The  disadvantages  of  this  form  of  spray  apparatus, 
which  make  it  inferior  to  the  use  of  compressed  air,  are 
the  length  of  time  that  it  takes  to  develop  the  propelling 
power  by  means  of  hand-ball  pressure,  and  the  fact  that 
both  of  the  operator's  hands  are  required  to  work  the  in- 
strument.    Both  of  these  points  are  of  importance  when 


A  Q  UM  ME  Die  A  TAL.  1 9 

the  latter  is  in  position  in   an   irritable  throat,  where  time 
is  all  requisite,  and  a  speedy  application  a  necessity. 

Larynx. 

To  make  an  application  to  the  larynx  with  this  instru- 
ment, the  patient  must  stand  or  sit,  facing  a  window,  so 
that  a  good  light  is  thrown  into  the  widely-opened  mouth  ; 
or,  still  better,  the  operator  should  use  the  concave  fore- 
head reflector,  with  artificial  light.  The  patient  draws  his 
tongue  well  out  of  the  mouth,  and  holds  it  between  two 
fingers  of  the  right  hand,  the  tongue  having  first  been 
covered  by  a  small,  clean  napkin.  The  operator  now 
carefully  passes  the  horizontal  bar  of  the  instrument,  on 
which  is  placed  the  tip  which  throws  the  spray  down- 
ward, well  back  into  the  pharynx,  without,  however 
touching  the  posterior  pharyngeal  wall,  and  holds  it 
steadily  with  his  left  hand,  in  a  position  which  his  ana- 
tomical knowledge  tells  him  is  such  that  the  point  of  the 
instrument  is  directly  above  the  mouth  of  the  larynx  (the 
laryngoscope  cannot,  of  course,  be  used  during  this  pro- 
cedure, as  both  of  the  operator's  hands  are  occupied). 
The  patient  now  takes  a  deep,  full,  and  quick  inspiration, 
at  the  same  moment  that  the  operator  begins  to  compress 
the  air-bulbs  of  the  apparatus  vigorously.  A  short,  sharp 
laryngeal  cough  will  be  the  evidence  that  the  spray  has 
entered  the  larynx. 

Pharynx. 

The  application  to  the  posterior  pharyngeal  wall  is  an 
easier  matter,  for  the  parts  are  directly  before  the  operator. 


20  PH ARM  A  COP  (EI A. 

and  under  his  vision.  The  patient  depresses  his  tongue 
by  means  of  a  spatula,  and  breathes  quietly.  The  proper 
tip  is  of  course  to  be  placed  on  the  spray  tube. 

Nasal  Passages. 

A  proper  application  with  the  "  hand-ball  spray  "  to  the 
posterior  nasal  passages  and  upper  pharynx  is  the  most 
difficult.  A  patient  is  rarely  found  with  a  throat  tolerant 
enough  to  allow  of  the  spray  being  thrown  with  this  in- 
strument up  behind  the  velum,  into  the  vault  of  the 
pharynx  and  posterior  nares.  Both  of  the  operator's 
hands  being  again  occupied  with  the  atomizer,  he  cannot 
use  the  "palate-hook  "  to  draw  the  velum  forward,  and, 
as  a  rule,  therefore,  he  had  better  confine  himself  to  ap- 
plications made  through  the  anterior  nares,  and  forced 
well  and  quickly  back  through  them  into  the  pharynx,  if 
he  employs  this  form  of  instrument. 

For  simple  applications  to  the  pharynx,  one  of  the  fol- 
lowing forms  in  default  of  other  apparatus  may  be  advan- 
tageously employed.  Their  use  is  far  superior  in  effective 
medication  to  that  gained  by  the  prescription  of  a 
gargle.  They  may  also  be  used  by  the  patient,  his  right 
hand  holding  the  instrument,  his  left  holding  the  spatula, 
by  means  of  which  he  depresses  his  tongue. 


AQUM  MEDICATE. 


21 


Fig.  12. — Atomizer  (with  re- 
movable tip)  throwing  a 
coarse  spray. 


Fig.    13. — Atomizer  throwing 
a  coarse  spray, 


^ 


Larynx  and  Pharynx. 

Astringent  Solutions.* 


Ferri  et  Ammonii  Sulphatis 
Zinci  lodidi  . 
Zinci  Chloridi 
Zinci  Sulphocarbolatis 
Ferri  Chloridi 
Ferri  Sulphatis 
Zinci  Sulphatis 
Cupri  Sulphatis 
Aluminis 
Acidi  Tannici 
Potassii  Chloratis 
Liquoris    Plumbi  Subacetatis 
Diluti         .... 


3  ss-  3  i  .ad 
gr.  X— XX 
gr.  x-xxx 
gr.  x-xx 

3  ss-  3  i 

3  ss-  3  i 

3  ss 

gr.  v-xv. 
gr,  x-xv 
gr.  v-xx 
3i 

TUXX-XXX 


aquae 


^  Stimulant. 

Argenti  Nitratis   .         .     gr  x,  xx,  xxx-  3  i  ad  aquae   3  i 


*  These  are  given  in  order  of  preference  as  to  use. — (Lefiferts.) 


3ss, 
3i 

ad  aquaS' 

gr.  ii-x 

«C                 (( 

gr.  ii-x 

a         a 

2  2  P^-A  RMA  COP  (EI A . 

-P,  Antiseptic. 

Acidi  Carbolici         .         .         gr.  lu-v  ad  aquae    %  i 
Potassii  Permanganatis     .  gr.  v-x 

Sodii  Benzoatis  .  .      gr.  xx-xxx    "        " 

Acidi  Sulphurosi       .         .         q.  s.  not  more  than  3  i 

at  each  application. 

-r>  Sedative. 

^  ..  .   . 

Potassii  Bromidi 

Ammonii  Bromidi    . 

Extracti  Opii 

Extracti  Belladonnse 

Liquoris  Morphinae  Sulphatis  (Magendie),  ttl  xii     " 

lodoformi       .         .         .         .         .         .  3 1 

^Etheris  Fortioris  .         .         .         .       '  .  1  i 

M.     Signa — Spray  in  Syphilitic  and  Phthisical  Laryngitis. 

Zinci  Chloridi gr.  xv 

Liquoris  Morphinae  Sulphatis  (Magendie),       3  i 

Glycerini 3  ss 

Aquae ad       §  i 

M.     Signa — Spray  in  Laryngeal  Phthisis. 

^  Anti-Diphtheritic. 

Acidi  Lactici         .         .         TU  xxx  ad  aquae   %  i 
Sodii  Salicylatis  .         .       3  i  ad  aquae   |i 

Liquoris  Calcis  (U.  S.  P.)     .      q.  s. 

Nasal  Passages  and  Vault  of  the  Pharynx. 

Applications  to  these  parts  should  always  be  employed 
of  a  strength  that  will  cause  no  irritation  of  the  mucous 
membrane, — one  much  more  susceptible  than  either  that 
of  the  pharynx  or  larynx.  A  preliminary  trial  of  the 
strength  of  the  solution  should  always  be  made. 


AQUJS  MEDIC  ATM. 


23 


The  following  are    the   ones   ordinarily  used  by   me, 
given  in  order  of  preference  : 

1^ 


Zinci  lodidi 

gr.  V  ad 

aquae   |  i 

Zinci  Sulphocarbolatis 

gr.  V   " 

Zinci  Sulphatis 

gr.  V   '' 

Ferri  et  Aramonii  Sulphatis 

gr.  V   " 

Ferri  Chloridi 

gr.  V   '1 

Acidi  Tannici           .           gr. 

v-xx 

Potassii  Chloratis 

3i      " 

The  above  are  suited  for  cases  of  Simple  Chronic  Rhin- 
itis and  Hypertrophic  Rhinitis  in  its  earlier  stages  ;  still 
later  in  the  latter  disease  the  following  may  be  used : 
(See  also  rules  for  cleansing,  page  4.) 

lodi  ... 

Potassii  lodidi    . 

Zinci  lodidi 

Zinci  Sulphocarbolatis 

"  Listerine  "  *      . 

Aqu?e  .         .         .         .         .         .ad 

M.     "Spray." 


gr.  IV 

gr.  X 

3i 

3i 

f  i 

\  iv 


*  The  *'  Listerine  "  in  this  formula  is  a  preparation  recently  intro- 
duced to  the  Profession  by  Lambert  &  Co.,  of  St.  Louis,  containing 
the  essential  antiseptic  constituent  of  thyme,  eucalyptus,  baptisia, 
gaultheria,  and  mentha  arvensis  in  combination.  Each  fluid-drachm 
also  contains  two  grains  of  refined  and  purified  benzo-boracic  acid. 
Thus,  it  may  be  used  in  this  formula  and  in  the  majority  of  the  solu- 
tions of  astringents  etc.,  that  have  been  mentioned,  as  a  men- 
struum, in  the  proportion  of  one  part  "  Listerine  "  to  two  of  water.  It 
will  be  found  to  serve  a  useful  and  pleasant  purpose  where  the  addi- 
tion of  an  antiseptic  is  desirable.  The  thyme  and  eucalyptus,  besides 
being  disinfectants,  act  also  as  stimulants  to  the  mucous  membrane, 
the  benzo-boracic  acid  as  an  emollient. 


^4  PHARMACOPCEIA. 

In  Atrophic  or  Fetid  Rhinitis,  the  indications  for  treat- 
ment are  twofold  :  first,  to  cleanse  and  disinfect,  and 
then  to  keep  clean  and  disinfected,  the  nasal  passages  of 
all  decomposing  crusts  and  secretions  ;  and,  second,  to 
stimulate  the  atrophied  mucous  membrane,  with  a  view 
to  the  regeneration  of  function  and  character  of  secretion 
in  the  muciparous  follicles  and  serous  glands,  if  this  latter 
can  be  accomplished,  a  matter  which  my  experience  has 
led  me  strongly  to  doubt.  The  first  indication  is  met  by 
the  daily  use  of  the  anterior  or  post-nasal  syringe,  occa- 
sionally by  the  necessary  direct  removal  of  hard  crusts 
by  means  of  forceps,  and  thorough  washing  of  the  pas- 
sages \vith  an  antiseptic  and  alkaline  solution  until  all 
offending  secretions  are  removed.  Formulae  for  this  pur- 
pose have  been  given  (see  page  lo). 

The  second  indication  requires  the  use  of  such  drugs 
as  sanguinaria,  galanga,  carbolic  acid,  creosote,  salicylic 
acid,  iodine,  bromide  of  potassium,  etc.,  which  are  recom- 
mended as  efficient  in  the  early  stages  of  the  disease. 
They  are  mentioned  in  the  order  of  preference.  They 
probably  act  by  giving  rise  to  a  local  irritation  of  the  mu- 
cous membrane,  which  in  turn  leads  to  a  stimulation  of 
the  glandular  structures,  and  an  increased  discharge  of 
serum  and  mucus. 


IV. 


COLLYRIA— MEDICINAL    SOLUTIONS 
FOR  LOCAL  APPLICATION. 


Used  with  the  laryngeal  brush,  to  the  larynx,  or  by  means  of  a 
large  camel's-hair  pencil,  to  the  pharynx. 


Fig.  14. — Brushes  for  the  larynx. 


Fig,  15. — Brush  for  the  pharynx. 

The  use  of  some  one  of  the  following  solutions  is  indi- 
cated in  ail  chronic,  and  in  many  sub-acute,  inflammatory 

25 


26  PHARMACOPCEIA. 

affections  of  the  larynx  and  middle  pharynx.  In  acute 
inflammations  of  these  parts,  their  employment  is,  as  a 
rule,  contra-indicated.  Applications,  to  be  of  service, 
must  be  thoroughly,  skilfully,  and  regularly  made,  to  the 
affected  mucous  membrane.  In  chronic  affections,  daily 
applications  for  the  first  week,  on  alternate  days  during 
the  second  and  third  weeks,  twice  in  the  fourth  week  and 
thenceforth  at  gradually  increasing  intervals,  according 
to  the  indications  presented  in  the  given  case,  will  be  a 
safe  general  rule. 

Alternation  of  the  remedies  is  sometimes  of  service  in 
old  and  inveterate  cases.  The  same  rules  will  apply  to  the 
use  of  the  medicated  sprays  (see  page  13). 

The  laryngoscopic  mirror  should  always  be  used  as  a 
guide  to  the  introduction  of  the  brush  into  the  interior 
of  the  laryngeal  cavity. 

Astringent. 

^        .  ..  . 

Ferri  et  Ammonii  Sulphatis  ,        ,        .         3  i 

Glycerini. 

Aquae    .        .        ...        .        •        aa      |  ss 

M. 

Zinci  lodidi 3  ss 

Glycerini. 

Aquae aa      1  ss 

M. 

^    .     . 

Zinci  Sulphocarbolatis  ■,        •         .         3  ss 

Glycerini. 

Aquae aa      ^  ss 

M. 


COLLYRIA. 

Zinci  Chloridi       .... 

Glycerini. 

Aquae    . 
M  .... 

Tincturse  Ferri  Chloridi 

Glycerini. 

Aquae    . 
M     "  •         .         .         . 

Ferri  Sulphatis       .... 

Glycerini. 

Aquae    . 
M  •         .         .         . 

Zinci  Sulphatis     .  . 

Glycerini. 
Aquae  . 
M 

Aluminis      ..... 

Glycerini. 

Aqu^  . 
M  .... 

Stimulant. 

Argenti  Nitratis         .          .          gr.  x,  xx,  xxx,  3  i 
Aquas         .  2  ,• 

M.  ^ 

Cupri  Sulphatis  .  .  .  .  gr,  xv 

Glycerini. 

^/qu^        •         .         .         .         ,  aa      3  ss 

M. 


27 


gr.  XV 

aa 

!   ss 

3 

i-3   ii 

aa 

3   ss 

. 

3  ii 

aa 

f   ss 

. 

3   ss 

aa 

3   ss 

3   i 

aa 

X  ss 

28  P  HARM  A  COP  (EI A , 

Antiseptic. 

Acidi  Carbolici  Puri    .         .         .         .         lU  xv 
Glycerini. 

Aquae  .         .         ,         .         .         .    aa      |  ss 

M. 

Stimulant,  Alterative,  and  Resorptive. 


Tincturse  lodi     . 

•         •         • 

.    TU  iv,  xii 

Potassii  lodidi    . 

•         •         • 

.      gr.  v-x 

Glycerini. 

Aquae 

. 

aa         §  ss 

M. 

]^ 

lodi     . 

o                                 •                                 • 

gr.  ii 

Potassii  lodidi     . 

.                   *                   • 

gr.  iv 

Zinci  lodidi. 

Zinci  Sulphocarb 

olatis 

aa  gr.  x 

Glycerini. 

Aquae 

.         •         • 

aa     1  ss 

M. 

- 

Glycerita. 

The  following  glycerites  of  the  U.  S.  P.  1870  may  also 
be  used  as  local  applications  to  the  larynx . 

Glyceritum  Acidi  Carbolici, 
Glyceritum  Acidi  Gallici. 
Glyceritum  Acidi  Tannici. 
Glyceritum  Amyli  (U.  S.  P.  1880). 
Glyceritum  Sodii  Boratis. 


V. 
PULVERES.— POWDERS. 


For  insufflation  into  the  larynx  or  nasal  passages  by  means  of  an 
appropriate  form  of  powder-blower. 

Larynx. 

Opinions  will  be  found  to  vary  as  to  the  efficacy  of 
medicated  powders  in  the  treatment  of  laryngeal  disease. 
The  German  and  English  method  still  retains  them.  In 
America  they  are  not  commonly  used.  In  Acute  and 
Sub-acute  Laryngitis,  as  well  as  in  some  grades  of,  specially 
Phthisical  and  in  Syphilitic  Laryngitis,  they  are  occasion- 
ally indicated.  On  the  other  hand,  in  advanced  Chronic 
Laryngitis  they  are  of  little  or  no  service.  For  use  in 
Tracheal  affections  they  have  been  strongly  recommended. 
Should  their  use  be  determined  upon  in  a  given  case,  the 
powder  selected  may  be  applied  to  the  larynx  by  means 
of  one  of  the  following  forms  of  apparatus,  ;  the  same 
rules  being  observed  as  in  the  case  of  the  use  of  the 
laryngeal  spray  (seepage  13).  The  laryngoscopic  mirror 
should  always  be  employed  to  ensure  accurate  application 
of  the  powder. 

29 


30 


PHARMA  COP  (EI A . 


Fig.  i6. — Powder  insufflators  for  the  larynx. 

Astringent.* 


1^ 


Acidi  Tannici. 
Pulveris  Amyli 
M. 

aa    3  ii 

Aluminis. 
Pulveris  Amyli 

M. 

aa    3  ii 

Sedative. 

Morphinse  Acetatis 
Pulveris  Amyli       .         ... 
M. 

gr.  ii,  v,  viii,  x 

1  ss 

*  See  also  nasal  powders. 


FUL  VERES.  31 

This  powder  should  be  well  prepared  in  a  mortar,  so  that  the  Mor- 
phine is  thoroughly  incorporated.  The  strength  of  the  special  powder 
selected  will  depend  upon  the  degree  of  sedative  action  required. 
Only  a  small  portion  of  powder  is  placed  in  the  insufflator  at  each  ap- 
plication. 


Morphinae  Acetatis         .         .         gr. 
lodoformi 

ii,  V,  ■ 
ad 

viii,  X 
1  ss 

M. — (See  rule  for  Dreparation  and  use  given  above.) 

lodoformi. 

Bismuthi  Subnitratis  * 

M. 

aa 

3ii 

lodoformi 

q.  s. 

Bismuthi  Subnitratis 
Pulveris  Amyli        .... 
M. 

ad 

3  iii 
I  ss 

Sodii  Boratis           .... 
Pulveris  Amyli        .... 

M. 

'ad 

3  iii 

I  ss 

*  1l\iq  Bismzithi  Oxychloridum,  (BiClg,  Bi203)2  HgO,  is  preferred 
by  Mackenzie  as  being  more  impalpable  and  less  irritating  than 
either  the  carbonate,  subnitrate,  or  oxide  of  bismuth.  It  is 
also  less  soluble,  which  renders  it  better  adapted  to  produce  the  me- 
chanical effect  of  forming  a  coating  over  inflamed  or  raw  mucous 
surfaces.  It  may  be  prepared  by  slowly  pouring  a  solution  of  bis- 
muth in  nitric  acid  into  a  solution  of  sodium  chloride. 


3  2  FHA  RMA  COF  (EI A . 

Nasal    Passages. 

In  cases  where  medicated  spray  applications  are  not 
well  borne  by  the  nasal  mucous  membrane,  causing  pain 
and  irritation,  or  perhaps,  in  any  case,  in  accordance 
with  the  special  views  of  the  physician,  a  medicated  pow- 
der may  be  substituted.  Powders  are  particularly 
adapted  to  the  treatment  of  Simple  Chronic  Rhinitis,  where 
the  secretions  are  readily  removable,  the  parts  soft  and 
absorptive.  In  Hypertrophic  Rhinitis  they  are,  I  believe, 
of  little  use,  and  in  Atrophic  or  Fetid  Rhinitis  contra- 
indicated. 

The  forms  of  powder  insufflator  adapted  for  the  treat- 
ment of  diseases  of  the  nasal  passages  are  shown  in  the 
following  wood-cuts.  One  is  arranged  to  deliver,  by 
means  of  the  air-pressure  developed  by  the  hand-ball, 
a  charge  of  the  finely  pulverized  powder  with  which  the 
bottle  is  charged,  into  the  anterior  nares.  The  other, 
with  a  longer  curved  tube, — which  shoul-d  be  introduced 
with  care  behind  the  velum  of  the  patient, — performs  the 
same  operation  in  the  posterior  nares  and  vault  of  the 
pharynx. 


Fig.  t  7. — Powder  insufflator  for  the  anterior  nares. 


PULVERES. 


33 


Fig..  i8. — Powder  insufflator  for  the  posterior  nares. 


^ 


Pulveris  Folise  Belladonnse 
Pulveris  Morphinse  Sulphatis 
Pulveris  Acacise 


ad 


M.     Signa. — For  Acute  Coryza. 

Morphinse  Sulphatis  .... 
Bismuthi  Subnitratis  .... 
Pulveris  Acacise  .... 

M.     Signa. — "  Ferrier's  Snuff,"  for  Acute  Coryza. 

Pulveris  Camphorse  .... 
Acidi  Tannici  ..... 
Pulveris  Sacchari  Lactis     .         .         ad 

M.     Signa. — For  Acute  Coryza  in  infants. 


gr.  XX 

gr.  ii 
X  ss 


gr.  1 

3iii 

3i 


3ii 
3  ss 
5  ss 


The  following  powders  may  be   used  for  the  forms  of 
Simple  Chronic  Rhinitis  : 


34 


PHA  KM  A  COP  CEIA . 


n 


Pulveris  lodoformi 
Pulveris  Camphorse     . 
Pulveris  Acidi  Tannic! 
Pulveris  Acaciae 


ad 


M. 


T} 


Pulveris  Morphinse  Sulphatis 
Pulveris  Foliae  Belladonnse 
Hydrargyri  Chloridi  Mitis 
Sodii  Bicarbonatis 
Pulveris  Acacise 


ad 


M. 


^  n 

3i 

gr.  V 

?  ss 


gr.  1 

gr.  X 

gr.  XX 

gr.  XV 

|ss 


^ 


Pulveris  Camphorse. 
Pulveris  lodoformi 
Pulveris  Acidi  Tannici  . 
Pulveris  Morphinse  Sulphatis 
Pulveris  Foli^  Belladonnfe.  . 
Pulveris  Acacias     . 


aa 

31 

. 

gr. 

iii 

•                  • 

gr. 

ss 

ad 

gr 

v 
ss 

M. 


1^ 


Morphinae  Acetatis 
Pulveris  lodoformi. 
Bismuthi  Subcarbonatis 
Pulveris  Acaciae    . 


gr.  IV 

aa   3  i 
ad        5  ss 


M. 


Pulveris  Cubebae  . 
Acidi  Salicylici     , 
Sodii  Bicarbonatis. 
Pulveris  Acacise    . 


M. 


3ii 
gr.  X 

aa   3  i 


PULVERES. 


35 


B 


Zinci  Chloridi 

Pulveris  Foliae  Belladonnae 

Pulveris  Acacias    . 


M. 


5 


Pulveris  Argenti  Nitratis 
Pulveris  Acacise    . 


gr.  V 

gr.  X 

ad        X  ss 


gr.  11,  IV,  VI,  X 
^  ss 


5 

Pulveris  Acidi  Tannici  *       3  ss  ad  Pulveris  Acacise   f  ss 
Aluminis     .         •  gr.  x 
Acidi  Salicylici  .  3i 
Ferri  et  Ammonii 

Sulphatis         .  gr.  x 
Ferri  Sulphatis    .  gr.  x 
lodi    .         .         ,  gr.  i,  ii 
Potassii  Bromidi   3  i 
PotassiiChloratis  gr.  xv 
Sodii  Salicylatis     3  ss 
Zinci  Sulphatis      3  i 
Zinci  Chloridi       gr.  v 
Belladonnas  Foliae  3  ss 
Catechu     .         .     3  ss 
Galangae    .         .     i  ss 
Sanguinariae       .     3  ii 

*  Many  of  the    following  powders  are  equally  well  adapted   for 
insufflations  into  the  larynx.     (See  page  29.) 


VI. 

BUGINARIA— NASAL  BOUGIES. 

Medicated  Bougies  for  tlie  treatment  of  the  various 
chronic  affections  of  the  nasal  passages  have  been  advised 
by  Catti  of  Vienna  (Zur  Therapie  der  Nasenkrankheiten, 
Wie7ier  medizinische  Zeitung,  1876).  They  are  made 
of  medicated  gelatin,  and  are  a  little  over  three  inches  in 
length,  slightly  conical,  about  one  quarter  of  an  inch  in 
diameter  at  the  thick  end,  and  taper  almost  to  a  point. 
Their  introduction  into  the  nasal  passage  is  attended 
with  no  difficulty,  if  a  rotary  as  well  as  an  onward 
motion  is  given  to  them  during  their  passage.  The 
elastic  body  of  the  bougie  adapts  itself  to  every  irregu- 
larity in  the  nasal  cavity,  passes  very  easily  through  the 
narrower  parts  of  the  meatus,  and  dilates  the  parts  by 
gentle  pressure.  After  their  introduction  in  the  manner 
described,  the  nostril  is  plugged  loosely  with  cotton,  in 
order  to  prevent  the  liquefied  gelatin  from  escaping  by 
any  other  orifice  than  that  of  the  posterior  nares.  The 
bougie  will  melt  in  from  twenty  minutes  to  an  hour, 
depending  upon  the  amount  of  secretion  present,  in  the 
given  case.  It  is  evident  that,  by  their  use,  a  medica- 
ment is  gradually   and    persistently  brought  in   contact 

36 


BUGINARIA. 

37 

with  the  affected  mucous  membrane,  and  that  gentle  dila- 

tation of  the  passage  is  effected. 

The  following  formulae  are  procurable  * — each  bougie 

contains : 

I   Acidi  Carbolici gr.  4-     . 

2  Acidi  Salicylici  . 

gr.  i 

3  Acidi  Tannici 

gr.  i 

4  Belladonnse  Ext.  Ale. 

gr.  i 

5   Ergotse  Ext. 

gr.  V 

6  Hydrastis  Ext.  Fid.    . 

TTL  V 

7  lodoformi 

gr.  ii 

8  lodoformi 

gr.  V 

j  lodoformi 

gr.  ii 

9     (  Belladonnae  Ext. 

gr.  i 

lo  Kramerise  Ext.    . 

gr.  iii 

II   Liquoris  lodi  Comp.  . 

m  V 

12  Liquoris  lodi  Comp.  . 

m  X 

j  Liquoris  lodi  Comp. 

m  V 

^^     (  Acidi  Carbolici 

mi 

14  Morphinae  Sulphatis    . 

gr.  i 

15   Opii  Extracti 

gr.  1 

16  Sanguinariae  Ext.  Fid. 

m  ii 

17  Zinci  Salicylatis 

gr.  i 

18  Zinci  Sulphatis 

gr.  i 

j  Zinci  Sulphatis 
^    I  Acidi  Carbolici 

gr.  1 

gr.  i 

{  Zinci  Sulphatis 

gr.  i 

20    \  Acidi  Carbolici 

gr.  i 

(  Hydrastis  Ext.  Fid. 

m  V 

j  Zinci  Sulphatis. 

« 

^^    \  Opii  Ext. 

aa      gr.  i 

j  Zinci  Sulphatis 

1  Belladonnas  Ext.  Ale. 

gr.  1 
.         gr.i 

j  Zinci  Sulphatis 

gr.  1 

^^     I  Morphinae  Sulphatis 

gr.  \ 

24  Zinci  Chloridi     . 

gr.i 

*  Manufactured  by  Mitchell,  Phila..  Pa. 


38  PHA  RMA  COP  (EI A . 

The  following  suggestions  as  to  their  use  are  offered  : 
Simple    Chronic    Nasal    Catarrh,  with  free    secretion, 
numbers  i8,  24,  6,  19,  20,  21,  22,  23,  3,  10. 

Hypertrophic  Nasal  Catarrh,  numbers  7,  8,  9,  and  the 
above. 

Atrophic  Nasal  Catarrh,  numbers  6,  4,  16,  i,  2,  11,  12, 
13- 

Fetid  Nasal  Catarrh,  Syphilitic  and  Strumous  Ozaena, 
numbers  7,  8,  i,  2,  17,  9. 


VII. 

GOSSYPIA— MEDICATED     COTTON- 
WOOLS. 

Cotton  tampons,  medicated  by  the  addition  of  various 
drugs,  are  recommended  and  used  in  the  treatment  of 
some  of  the  affections  of  the  nasal  passages  and  naso- 
pharyngeal region,  by  certain  authorities.  Such  desira- 
ble results  as  they  may  effect  are  based  upon  the  same 
principle  as  that  of  the  use  of  the  medicated  nasal  bou- 
gies, to  which,  however,  they  are  far  inferior  (see  page  36.), 
viz.  :  that  the  medicament  is  persistently  brought  and 
maintained  in  contact  with  the  diseased  mucous  mem- 
brane. They  are  of  value  m.ainly,  I  believe,  for  their  anti- 
septic and  haemostatic  effects.* 

The  indications  for  their  employment  will  be  apparent 
from  their  constitution. 

Borated  Cotton  (15  fo  Boracic  Acid  in  solution). 

Borated  Cotton  (45  ^  Boracic  Acid  in  solution). 

Carbolated  Cotton. 

Haemostatic  Cotton  (Subsulphate  of  Iron  45  </o). 

Iodized  Cotton  (5  ^). 

Iodoform  Cotton  (y^  ^). 

Salicylated  Cotton. 

Styptic  Cotton  (Perchloride  of  Iron). 

Tannated  Cotton. 

*  Manufactured  by  C.  Am  Ende,  Hoboken,  N.  J. 
39 


VIII. 

INHALATIONES— INHALATIONS. 

Inhalations  are  divided  into  three  classes  :  A — Vapores 
Calidi,  or  Steam  Inhalations  ;  B — Nebulae,  or  Atomized 
Fluid  Inhalations  ;  and  C — Fumi,  or  Fuming  Inhalations. 

A. — Vapores    Calidi — Steam    Inhalations. 

The  employment  of  hot  moist  air  (steam),  charged 
with  a  volatile  matter,  which  latter  should  possess  a  de- 
cided and  remedial  action,  is  of  the  greatest  value  in  the 
treatment  of  all  acute  and  sub-acute  inflammatory  diseases 
of  the  larynx,  and  specially  of  those  of  the  tonsils  and 
pharynx.  In  chronic  affections  of  these  parts  they  are 
of  less  worth. 

The  inhalations  can  very  properly  be  entrusted  to  the 
patient,  and  thus  form  an  adjuvant  to  the  local  and  direct 
treatment  adopted  by  the  surgeon. 

Their  curative  effect  is,  no  doubt,  in  great  part  due  to 
the  hot  moist  air,  and  this  alone  in  most  cases  may  be 
used  successfully  in  default  of  the  proper  medicament ; 
the  latter,  however,  in  certain  instances,  at  least,  imparts 
a  remedial  character  to  the  steam,  which  is  desirable. 

40 


IN  HA  LA  T JONES 


41 


A  variety  of  *'  Inhalers  "  are  readily  procurable — some 
at  moderate  cost.  The  best  known  are  those  of  Macken- 
zie, the  "  Eclectic  Inhaler,"  Bullock's  "  Hospital  Inhaler," 


Fig.  ig. — The  Eclectic  Inhaler. 


Martindale's  "Portable  Inhaler"  (for  illustrations  of 
these  see  the  ""  Pharmacopoeia  of  the  Hospital  for  Dis- 
eases of  the  Throat,"  London,  fourth  edition,  pp.  67,68), 
and  the  various  forms  of  Earthen-ware  Inhaler,  made 
by  Maw,  of  London.  The  latter  have  always  served  a 
good  purpose  in  my  hands. 


42 


P  HARM  A  COPCEIA , 


Fig.  20. — Maw's  Inhalers. 

The  ordinary  "  croup-kettle,"  with  its  long  nozzle,  an- 
swers a  ready  purpose,  and  is  most  convenient  should 
the  patient  be  obliged,  from  the  nature  of  his  disease,  to 
recline  in  bed  during  the  inhalation. 

An  earthen-ware  pitcher,  a  small  tin  pail, — in  short,  any 
receptacle  in  which  the  boiling  water  with  the  desired 
quantity  of  the  drug  may  be  placed,  will  be  efficient  in 
the  absence  of  more  costly  but  perhaps  more  convenient 
apparatus.  In  the  latter  instances  the  steam  may  be 
directed  to  the  mouth  of  the  patient  by  means  of  a  thick 
paper  cone,  the  large  end  of  which  covers  in  the  vessel. 

Rules  for  Use. 


Steam  inhalations  should  be  used,  as  a  rule,  at  a  tem- 
perature of  140°,  rarely  over  150°,  never  over  160°.  Un- 
der 130°  they  are  of  little  use,  unless  Ammonia  is  used 
(Mackenzie). 


INHALA  TIOXES. 


43 


The  "  Inhaler  "  having  been  filled  with  one  pint  of 
water  at  a  proper  temperature,  and  the  medicament 
added,  if  one  be  used,  the  patient  seats  himself  or  reclines 
upon  his  bed  in  a  convenient  attitude,  and  either,  accord- 
ing to  the  nature  of  the  case,  /,  ^.,  whether  it  be  one  of 
laryngeal  or  pharyngeal  inflammation,  inhales  the  steam 
by  a  series  of  deep  inspirations — six  to  the  minute  in  the 
former  instance, — or  simply  allows  it  to  enter  his  open 
mouth,  he  breathing  normally,  and  thus  inhaling  it  slow- 
ly, in  the  latter. 

The  process  may  be  repeated,  in  acute  affections,  every 
two  or  three  hours,  or  even  oftener  if  it  be  grateful  to  the 
patient,  and  for  from  four  to  five  minutes  at  a  time. 

As  a  rule,  inhalations  should  not  be  given  after  meals, 
and  care  is  always  requisite  that  the  patient  does  not  ex- 
pose himself  to  cold  external  air  immediately  after  their 
use. 

The  following  Formulae,  with  the  indications  for  their 
employment,  are  selected  from  those  in  use  at  the  Hos- 
pital for  Diseases  of  the  Throat,  London,  and  consist  of 
the  ones  best  adapted  for  general  requirement  in  the 
treatment  of  laryngeal,  tonsillar,  and  pharyngeal  diseases. 

The  following  general  remarks  regarding  their  prepa- 
ration apply  to  all  : 

In  the  case  of  most  of  the  essential  oils  (which  may  be 
increased  in  quantity,  according  to  the  indications  of  the 
case,  or  several  of  the  volatile  oils  may  be  advantageously 
and  pleasantly  combined  with  other  remedies  in  the  same 
prescription).  Light  Carbonate  of  Magnesia  is  used  to 
hold   the   oil  in   suspension,  in  the   proportion  of  half  a 


44  PHA  RMA  COP  (EI A . 

grain  of  Magnesia  to  each  drop  of  oil.  Prepared  Kaolin 
(native  white  Silicate  of  Alumina  which  has  been  purified 
by  elutriation  from  free  Silica  and  undecomposed  Fel- 
spar) is  even  better  than  the  Magnesia  for  this  purpose, 
as  the  latter  forms  in  time  non-volatile  combinations  with 
some  of  the  essential  oils. 

The  quantities  of  ingredients  in  the  Formulae  are  gen- 
erally prescribed  for  one-ounce  mixtures^  a  teaspoonful  of 
which  is  added  to  2ipmt  of  water,  at  the  required  temper- 
ature, for  each  inhalation. 

Vapor  Acidi  Benzoici. 

Acidi  Benzoici  .....  gr.  iii 

Kaolin        ......  gr.  xii 

Rub  together  and  add 

Tincturae  Tolutanae    .         .         .         .       TT[  xviii 
Aquse         ......  |  ss. 

Shake,  and  make  up  the  quantity  with  water  to  one 
ounce. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

Use. — ^\^ery  serviceable  in  Acute  Affections  of  the  Air  Passages. 

Vapor  Benzoini. 

Tincturae  Benzoini  Compositae    .         .         •      1  i 
A  teaspoonful  in   a  pint  of   water  at  140°  F.  for  each 
inhalation. 

Use. — A  valuable  sedative  inhalation  for  Acute  Inflammations  of 
the  Pharynx  and  Larynx,  specially  in  their  earlier  stages. 


INHALA  TIONES.  45 

Vapor  Ammonii  Benzoatis. 

Acidi  Benzoici           .         .         .         .  gr.  viii 

Spiritus  Ammonise  Aromatici    .         .  §  ss 

Spiritus  Camphorae    ....  3  iii 

Spiritus  Vini  Rectificati     ...  3  i 

Dissolve,  and  mix.    A  teaspoonful  in  a  pint  of  water  at 
8o°  to  ioo°  F.  for  each  inhalation. 

Use. — Stimulant  in  the  later  stages  of  Acute  Inflammations. 


Stimulants. 

Vapor  lodi  Benzoinati. 

Acidi  Benzoici  .....  gr.  xvi 
Tincturae  lodi   .....  §  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

Use. — Stimulant. 

Vapor  Cubebae. 

Olei  Cubebae  .  .  •  .  .  TTj,  xi 
Magnesii  Carbonatis  .  .  .  .  gr.  xx 
Aquae  ......         ad  51 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

Use. — A  valuable  stimulant,  especially  in  Laryngorrhcea. 


46  PHA  RMA  COP  (EI A . 

Vapor  Cubebae  Cum  Limone. 

Olei  Cubebae 3  ss 

Olei  Limonis  *     .         .         .         .         .  fU  x 

Magnesii  Carbonatis    .         .         .         .        gr.  xx 
Aquae ad  |  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

Use. — A  valuable  stimulant. 

Vapor  Juniperi  Anglici. 

Olei  Juniperi  Anglici  .         .         .         .         fTi  xx 
Magnesii  Carbonatis   .         .         .         .  gr.  x 

Aquae  .....         ad  |  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

l/se. — An  excellent  stimulant  in  cases  of  vocal  weakness. 

Vapor  Ammoniae.f 

Aquae  Ammoniae. 

Aquae aa   3  iv 

A  teaspoonful  in  a  pint  of  water  at  80°  F.  for  each 
inhalation. 

Wse. — Stimulant ;  useful  in  Chronic  Laryngitis  and  Functional 
Aphonia. 

*  The  oil  of  lemon  is  used  to  mask  the  disagreeable  odor  of  the 
cubebs.  It  may  be  used  as  a  fragrant  addition  to  many  other  inha- 
lations. 

f  This  inhalation  may  be  advantageously  employed  in  combination 
with  any  of  the  volatile  oils,  or  with  Camphor  or  Thymol.  In  such 
case  Kaolin  is  to  be  used  for  keeping  the  oils  in  suspension,  in 
place  of  Light  Carbonate  of  Magnesia, 


INHALA  TIONES.  4/ 

Vapor  Calami  Aromatici. 
B 

Olei  Calami  (P.  G.)       .  .         .         .         m  v 

Magnesii  Carbonatis      .  .         .          •     gr.  iiss 

Aqu£e    .         .         .         .  .         .         ad         |  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140^  F.  for  each 
inhalation. 

Use. — A  powerful  stimulant.  It  often  acts  admirably  in  cases  of 
Chronic  Congestion  of  the  Larynx  when  other  stimulating  inhalations 
have  lost  their  effect. 

Vapor  Camphorae. 

Spiritus  Camphorae  *     .  .  .  .            3  i 

Spiritus  Vini  Rectificaii  .  .  .         3  iii 

Aquae    .         .         .         .  .  .  ad        f  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

Use. — Stimulant,  valuable  in  Chronic  Glandular  Laryngitis. 

Vapor  Creasoti. 

Creasoti flllxxx 

Magnesii  Carbonatis             .         .         •  gr.  xxxx 

Aquae  .         .         .         .         .         ad          |  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  eacli 
inhalation. 

Use. — Stimulant  ;  a  very  serviceable  remedy  for  Chronic  Conges- 
tion of  the  Larynx  and  Trachea. 

*  Spirits  of  camphor  in  the  proportion  of  one  drachm  to  the  ounce 
of  inhalation  mixture  will  be  found  a  useful  additional  stimzila7it  to 
many  of  the  other  inhalations.     (See  also  above — Ammonia.) 


48  PHARMA  COFCEIA . 

Vapor  Myrti. 

Olei  Myrti  1U  vi 

Magnesii  Carbonatis     .         .         .         .        gr.  iii 
Aquas  .         .         .         .         .         ad  f  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

Use. — Stimulant  ;  useful  in  Acute  Tonsillitis. 

Vapor  Pini   Sylvestris. 

Olei  Pini  Folii  (Fir-leaf  Oil)  *  .  .        m  xl 

Magnesii  Carbonatis     .         .  .  .       gr.  xx 

Aquae    .          .          .         .         .  .  ad          f  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

Use. — A  mild  but  useful  stimulant  in  Chronic  Larjmgitis. 

Vapor  Thymolis. 

Thymolis  f     ,  .  .  .         .         .       gr.  vi 

Spiritus  Vini  Rectificati         .         .         .  3  i 

Magnesii  Carbonatis       .         .         .         .       gr.  iii 

Aquae     .         .         .         .         .         .         ad        §  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  for  each 
inhalation. 

Use. — A  strong  stimulant  and  disinfectant  ;  useful  in  Phar}mgitis 
and  Laryngitis  when  associated  with  the  Exanthemata. 

*  This  oil  is  not  to  be  confounded  with  ordinary  Oil  of  Turpentine. 
It  is  prepared  from  the  leaves  of  the  Pinus  Sylvestris,  Linn.,  and  is 
imported  from  Germany  as  fir-leaf  oil  (Fichtennadelol).  It  may  be 
obtained  in  this  country  from  the  Gardner  Pine  Needle  Company, 
Sharon  Springs,  N.  Y. 

■j-  Thymol,  like  Camphor,  will  be  found  to  be  a  most  useful  addition 
to  many  of  the  essential-oil  inhalations  (see  Camphor — Ammonia). 


INHALA  TIOJVES.  49 

Vapor  Terebenis. 

Terebenis  Puri*    .  .         .         .         .       tt[  xl 

Magnesii  Carbonatis  ...  gr.  xx. 

Aquae     .         .         .  .         .         .         ad        |  i 

M. 

A  teaspoonful  in  a  pint  of  water  at  140°  F.  to  be  in- 
haled for  ten  minutes,  morning  and  night. 

Use, — As  a  stimulant. 

Vapor  lodi  Camphorati. 

Tincturas  lodi         .         .         .         .         .        |  ss 
Aquae  Ammonige  Fortioris      .         .         .   fTl,  xxx 
Spiritus  Camphorse         ....     3  iiiss 
M.  and  after  four  days  filter. 

A  teaspoonful  in  a  pint  of  water  at  80°  F.  for  each  in- 
halation. 

Use. — Stimulant  ;  also  used  for  Valsalvan  inhalation. 

Sedative. 

Vapor  Acidi  Hydrocyanici. 

Acidi  Hydrocyanici  Diluti     .         .         .  3  i 

Aquae     .         .         .         .         .         .         ad        f  i 

M. 

A  teaspoonful  in  one  pint  of  water  at  80°  F.  for  each 
inhalation. 

Use. — Sedative  ;  very  useful  in  the  cough  of  Laryngeal  Phthisis 
and  in  some  Spasmodic  Affections. 

*  Pure  Terebene,  an  isomer  of  Oil  of  Turpentine,  produced  by  the 
action  on  the  latter  of  Sulphuric  Acid  and  distilling  (see  "  National 
Dispensatory,"  p.  1019). 


50  PHARMACOPCEIA. 

Vapor  iEtheris. 

yEtheris  Fortioris. 

Spiritus  Vini  Rectificati  .         .         aa      §  ss 

M. 
A  teaspoonful   in  a  pint   of  water  at  80°  F.  for  each 

inhalation. 

Use. — Sedative   and  anti-spasmodic  ;    useful    in    Irritation  of  the 
Larynx. 

Vapor  Chloroform!. 

Chloroformi  Purificati, 

Spiritus  Vini  Rectificati   .         .         .         aa   |  ss 
M. 
A  teaspoonful  to  be  added  to  a  pint  of  water  at  the 

desired  temperature  (from  60°  to  ioo°F.),  and  an  addi- 
tional teaspoonful  to  be  added  every  five  minutes  during 
the  time  that  the  inhalation  is  used,  nor  more  than  three 
teaspooiiftds  to  be  used  on  2cny  single  occasion,  except  in 
the  presence  of  the  surgeon. 

Use. — Sedative  in  spasmodic  affections  of  the  Larynx. 

Anti-spasmodic. 

Vapor  Amyl  Nitritis. 

Amyl  Nitritis "fTl  viii 

Spiritus  Vini  Rectificati     ...  ?  i 

M. 

A  teaspoonful   in  a  pint  of  water  at   100°  F.  for  each 

inhalation. 

Use. — Anti-spasmodic  ;    very  valuable  in  some  cases   of  Asthma 
and  Spasm  of  the  Glottis. 


IN  HA  LA  TIONES. 


51 


Vapor  Acidi  Hydrocyanici  )  0      o.  a  v- 
Vapor  ^theris  Fortioris     ^  ^^^  ^^^^^' 


ves. 


Antiseptic. 
Vapor  Acidi  Carbolici. 


^ 


Acidi  Carbolici  Puri      .         .         .         .         q.  s. 
Twenty  drops  in  a  pint  of  water  at    140°   F.  for  each 
inhalation. 

Use. — Antiseptic;  useful  in  Tertiary  Syphilitic  and  Carcinomatous 
ulcerations  of  the  Throat. 

Vapor  Creasoti  ^ 

Vapor  Juniperi  Anglici  \  See  Stimulants. 

Vapor  Thymolis.  ) 


B.  Nebulae — Atomized,  Fluid  Inhalations. 


Fig.  21. — Steam  atomizing  apparatus. 

Medicated   waters,   atomized  by  means   of   the    steam 
atomizing  apparatus,  are,  I  believe,  of  doubtful  utility  in 


5  2  PHA  RMA  COP  (EI A . 

the  treatment  of  diseases  of  the  larynx,  specially  of  its 
chronic  affections.  In  the  pharynx,  on  account  of  the 
more  direct  and  easy  application  of  the  medicated  and 
atomized  fluid,  they  are,  perhaps,  of  more  service;  but 
even  here  are  inferior  in  their  remedial  effect  to  that 
obtained  by  the  use  of  a  medicated  spray  used  with  the 
compressed-air  apparatus  (see  page  13). 

The  "  Steam  Atomizer  "  requires  care  and  much  atten- 
tion to  detail  in  order  to  preserve  it  in  good  working 
order;  time,  which  it  is  difficult  to  persuade  the  patient 
with  a  chronic  affection  of  the  throat  to  take,  is  requisite 
for  its  daily,  thorough,  and  repeated  use.  Many  patients 
will  find  the  inhalation  of  such  an  atomized  fluid  into  the 
lower  portions  of  the  upper  respiratory  tract,  to  any 
degree  that  ensures  ef^ciency,  both  difficult  and  disa- 
greeable, often  impossible,  and  not  infrequently  irritating.^ 
Moreover,  I  do  not  question  but  that  the  use  of  the  hot 
steam,  which  is  here  the  propelling  and  atomizing  power, 
promotes  and  encourages,  in  chronic  affections  of  the 
throat,  the  very  features  of  the  disease,  which  it  is  intend- 
ed in  a  general  way  to  relieve,  viz.:  the  tumefaction, 
hypercemia,  relaxation,  and  hypersecretion  of  the  mucous 
membrane,  and  that  these  pernicious  effects  more  than 
outweigh  any  good  result  that  may  accrue  from  the  con- 
tact of  the  medicated  spray  with  the  diseased  localities. 

Rules  for  Use. 

If  the  apparatus  be  used,  it  should  be  more  persistently 
employed  than  is  usually  the  case  ;  once  or  twice  a  day  is 
not  too  infrequent  an  application  to  ensure  results.     The 


INHALATIONES.  53 

directions  which  accompany  the  instrument  should  be 
understood  and  carefully  followed.  The  latter  should  be 
arranged  upon  a  table  before  which  the  patient  is  seated 
at  a  suitable  heisrht.     If  the  atomized  and  medicated  fluid 

O 

is  intended  to  enter  the  larynx,  the  patient's  tongue,  cov- 
ered by  a  small  napkin,  must  be  well  drawn  out  of  his 
mouth  by  himself,  his  widely-opened  mouth  placed  in  the 
direct  line  of  the  cloud  of  spray  as  it  leaves  the  glass 
mouth-piece  of  the  instrument,  and  as  near  as  the  heat  of 
the  cloud  will  safely  allow  of,  and  a  quiet,  deep,  full  inspi- 
ration taken.  The  sensations  of  the  patient,  or  a  short, 
sharp,  quick  cough  will  show  that  the  larynx  has  been 
reached  by  the  atomized  fluid.  A  moment's  pause  is 
now  made,  and  the  process  repeated  ;  at  what  length  at 
each  sitting  and  with  what  frequency  will  depend  upon 
the  requirements  of  the  individual  case  and  the  character 
of  the  remedy  that  is  used.  To  enable  the  cloud  of  atom- 
ized solution  to  reach  the  pharynx  thoroughly,  the  pa- 
tient's tongue  must  be  well  depressed  by  means  of  a 
tongue-spatula,  and  full  inspirations  taken. 

The  following  are  the  principal  remedies  used  as  atom- 
ized fluid  inhalations.  The  stronger  astringent  solutions 
are  useful  in  Haemoptysis,  and  in  Laryngeal  Hemorrhage  ; 
the  lactic-acid,  lime-water,  and  salicylic-acid  solutions 
in  Diphtheria.  The  application  of  the  others  suggests 
itself. 


54 


PHA  jTAfA  COP  (EI A . 


fcJI 
c  - 


.a 


'T3 


CO 


c 


Q 

<- 


>       "^  "^  "^  --^ 


>  > 


>  > 


tJ3bJ3b/3EotJ3fcflb/)tjOt/3 


&  ti)  tiJ  t/J  Eo 


cr  5o     »-  cr  tx) 


Pi; 

< 

to 

t^Q-          ------- 

'3 

■C/3 


I 
< 

'a 


o  ^ 


c 


C/5  ..^     t/2 


'5    c 


c 


^  _a-;^  jir^  !£-    '£  u  £^  -2 


x^ 


i4  t- 


s  c 


N  N 


:a2 


-  -2 


cJ 

O 

N 

c 


t-iH  '-'  :S 


w 


w 


s 

o 

o 

O 


INHALATIONES.  55 

C,  Fumi — Fuming  Inhalations. 

Fuming  inhalations  are  specially  indicated  in  cases  of 
spasmodic  affections  of  the  larynx,  trachea,  and  bronchial 
tubes.  They  can  best  be  carried  out  by  steeping  unsized 
paper  in  a  solution  of  nitrate  of  potash  of  definite 
strength,  cutting  the  paper  into  strips  of  three  inches  long 
by  half  an  inch  broad,  lighting  the  paper  at  one  end,  and 
dropping  it  into  a  cylindrical  vessel,  four  inches  high 
by  two  in  diameter,  from  which  the  smoke  can  be 
inhaled  by  repeated  deep  inhalations.  It  will  be  found 
convenient  to  have  three  solutions.  No.  i. — Potassii  Ni- 
tratis,  gr.  xxx.,  ad  Aquae,  |  i.  No.  2. — Potassii  Nitratis, 
gr  xlv.,  ad  Aquae,  3  i,  and  No.  3. — Potassii  Nitratis,  3  i, 
ad  Aquae,   |  i. 

A  particular  character  may  be  given  to  these  papers  by 
the  addition  of  various  volatile  principles,  thus  Spirit  of 
Camphor  and  Oil  of  Cassia  increase  their  powers,  while 
Compound  Tincture  of  Benzoin,  Oil  of  Sandal,  and  Tinc- 
ture of  Sumbul  reduce  their  action  and  make  them  less 
irritating. 

The  medium-strength  nitrated  paper  (No.  2)  is  gener- 
ally employed  in  the  above  case,  and  the  best  method 
of  preparing  it  is  to  moisten  the  paper  in  a  tincture,  or, 
in  the  case  of  essential  oils,  in  a  solution  of  the  oil  (one 
drachm  dissolved  in  nine  drachms  of  rectified  spirit),  and 
then  expose  it  for  a  few  moments  in  order  to  allow  the 
spirit  to  pass  off. 

These  papers  should  be  kept  in  tinfoil,  or  prepared  iui 
small  quantities  as  required. 

From  one  to  six  papers,  according  to  the  indications  in  the 
particular  case,  should  be  used,  one  after  the  other,  at  each 
inhalation. — (London.  Throat  Hospital,  Pharmacopoeia.) 


IX. 


GARGARISM^— GARGLES. 

A  gargle — so-called — is  seldom  of  any  value,  if  it  be 
intended  by  its  use  to  medicate  parts  located  posteriorly 
to  the  anterior  pillars  of  the  fauces. 

A  careful  trial  in  individual  cases  will  demonstrate  that, 
as  a  rule,  the  act  of  gargling  is  incompletely, — the  poster- 
ior pharyngeal  wall  not  being  reached  by  the  fluid, — and 
therefore  uselessly,  performed. 

Gargles  are,  moreover,  contra-indicated  in  all  cases 
where  the  necessary  movements  of  the  parts  in  the  act  are 
painful  and  cause  irritation,  as  will  be  found  to  be  the 
case  in  most  acute  diseases  of  the  fauces  and  tonsils. 
For  these  reasons  their  employment  is  a  restricted  one. 
and  is  superseded  in  efficiency  by  the  direct  application 
of  a  medicated  solution  in  the  form  of  spray. 

Rules  for  Use. 

Should  they  be  prescribed — and  being  a  time-honored 
institution,  they  probably  will  continue  to  be — the  patient 
should  be  instructed  to  use  them  as  a  lotion  or  wash  for 
the  inflamed  surfaces,  as  far  as  they  can  be  reached,  and 
not  as  a  gargle, — that  is  to  say,  he  should  bring  the  medi- 

56 


GARGARISM^E.  57 

cated  fluid  into  contact  with  the  parts,  by  allowing  it  to 
flow  upon  them  by  gravity,  as  the  head  is  held  far  back- 
wards, or  still  better,  as  he  is  lying  upon  his  back,  with 
the  mouth  widely  opened,  and  the  head  turned  slowly 
from  side  to  side,  so  as  to  thoroughly  bathe  the  mucous 
membrane. 

At  least  half  a  fluid-ounce  of  the  lotion  should  be  taken 
into  the  mouth  on  each  occasion,  allowed  to  flow  into  the 
back  of  the  throat  and  retained  there  as  long  as  possible ; 
this  act  to  be  repeated,  and  its  repetition  ordered  from 
four  to  six,  or  even  more  times,  daily,  according  to  the 
indications. 

Used  in  this  manner,  a  lotion  possesses  a  certain 
degree  of  value  in  affections  of  the  mouth,  soft  palate, 
and  anterior  fauces;  to  a  lesser  degree,  in  those  of  the 
tonsils. 

If  a  lotion  is  prescribed  that  contains  a  mineral  acid, 
the  patient  must  be  cautioned  to  rinse  the  mouth  with 
water  after  its  use,  in  order  to  prevent  injury  to  the  teeth. 

Astringent. 

Ferri  et  Ammonii  Sulphatis          .         .  3  iss 

Glycerini      ......  |  i 

Aquae ad  f  viii 

M. 

Aluminis      ......  3  iss 

Glycerini      ......  §  i 

Aquai  .         p         .         .         „         ad     ^  viii 


58 


PHA  RMA  COP  (EI A , 


5 


M. 


Aluminis. 
Acidi  Tannic! 
Glycerin! 
Aquae 


Zinci  Chloridi 

Glycerini 

Aquae 


M. 

Zinci  Sulphocarbolatis 
Glycerini      .... 
Aquae  .... 

M. 

Pulveris  Krameriae 

Aquae  at  ioo°  C. 

Signa. — Infuse  for  one  hour  and  strain. 

Sodii  Boratis 
Tincture  Myrrhae 
Glycerini       .         „       .  . 
Aquae    .         .  .         . 

M. 


^ 


Acidi  Tannic! 
Acidi  Gallici 


M. 


aa 
ad 


ad 


ad 


ad 


3  iss 
§  i 

3  ^'iii 


3  ss 
;  viii 


3i| 

1  i 
viii 


3  IV 
viii 


3iv 

3SS 

1  i 
!  viii 


gr.  360 
sr.  120 


This  powder    should   be  thoroughly  mixed   and  then 
kept   in  a  glass-stoppered   bottle    ready   for    use.     It  is 


GARGARISM.'E. 


59 


gr- 

XX 

1  i 

^ 

viii 

3ii 

f  i 

Z 

viii 

useful  for  arresting  the  hemorr/iage  after  ainpuiatio7i  of  the 
tonsils.  A  small  quantity  may  be  prepared  at  the  time  of 
the  operation  by  mixing  with  a  little  water  so  as  to  form 
a  paste.  This  is  applied  to  the  cut  surfaces  by  means  of 
a  brush.     It  acts  quickly  and  effectually. 

Antiseptic  and  Stimulant. 

Acidi  Carbolici     ..... 
Glycerini       ...... 

Aquae ad 

M. 

Acidi  Acetici  ..... 

Glycerini       ...... 

Aquae ad 

M. 

6^j'^.-^Useful   in   the   sub-acute  inflammatory  affections  occurring 
during  the  course  of  the  exanthemata. 

Potassii  Chloratis           .         .         .         .  3  ii 

Glycerini        ......  ^  ss 

Aquae ad  |  viii 

M. 

Liquoris  Potassii  Permanganatis  (U.  S.  P.  1870.)    3  i 
Aquae     ...... 

M. 

Sodii  Sulphocarbolatis 
Sodii  Boratis  .... 

Glycerini        ..... 
Aquae     #,..,, 
M. 


ad 

!  viii 

ad 

3  ss 

3ii 

1  i 
3  viii 

6o  PHA  RMA  COP  (EI A , 

Sedative. 

Potassii  Bromidi    .         .         .         .         .  3  iss 

Glycerini        ......  ^  i 

Aquae ad  ?  viii 

M. 

The  following  Glycerites  of  the  U.  S.  P.  1870  not  in- 
frequently serve  a  ready  and  efficient  purpose  as  gargles. 
They  should  be  diluted  with  water  or  with  "  Listerine  " 
and  water  to  the  proper  strength  according  to  the  indi- 
cations : 

Glyceritum  Acidi  Carbolici. 
Glyceritum  Acidi  Tannici  vel  Gallici. 
Glyceritum  Sodii  Boratis. 

"  Listerine,"  *  diluted  with  from  two  to  sixteen  parts  of 
water,  makes  a  very  agreeable  and  useful  gargle.  It  may 
be  substituted  in  many  of  the  above  formulae  in  the 
place  of  the  Glycerine. 

*  See  page  23. 


X. 


TROCHISCI— LOZENGES,  PASTILS. 

Medicated  lozenges  or  pastes,  when  used  with  a  view  to 
an  immediate  local  effect,  not  infrequently  play  a  conven- 
ient and  useful  role  in  the  treatment  of  faucial  and 
pharyngeal  affections,  as  an  adjuvant  to  the  direct  local 
treatment  elsewhere  described.  In  laryngeal  diseases 
their  efficacy  is  more  doubtful,  but  certain  forms,  notably 
those  containing  Benzoic  Acid  or  Cubebs,  have  a  certain 
reputation  as  "  voice "  stimulants,  and  act  probably 
through  their  stimulant  qualities,  exciting,  by  the  medium 
of  the  pharyngeal  mucous  membrane,  a  reflex  influence 
upon  the  larynx,  by  the  path  of  the  pharyngeal  plexus  of 
nerves, — this  aside  from  their  mere  local  action  in  stimu- 
lating the  secretions  of  the  parts. 

Rules  for  Use. 

One  lozenge  may  be  taken  by  the  patient  into  his 
mouth  at  the  back  of  the  tongue  and  allowed  to  dissolve 
slowly  ;  four  or  five  times  daily,  the  saliva,  impregnated 
with  the  drug,  being  swallowed.  In  acute  affections, 
their  more  frequent  use  is  indicated.  No  fluids  should 
be  drunk  for  a  short  time  after  their  use. 

6i 


62 


PHARMA  COP  (EI A . 


D    \r. 

1 

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S  c 

iii 

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jj 

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o  '^ 

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S 

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"^    ci  "^ 

-^S 

X 

d  6 

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TROCHISCL  65 

Whistler— Pastilli. 

Pastils,  the  basis  of  which  is  Glyco-gelatine,  that  renders 
them  softer  and  more  mucilaginous  in  nature,  as  well  as 
more  palatable  both  in  appearance  and  taste,  than  the 
ordinary  lozenge  or  troch  made  with  fruit  paste  or  gum, 
were  introduced  originally  by  Dr.  Whistler,  as  a  special 
means  of  applying  Iodoform  to  the  throat,  (see  Medical 
Times  and  Gazette^  Nov.  1878).  Their  consistence  when 
freshly  made  is  that  of  firm  jelly,  in  order  that  they  may 
dissolve  readily  in  the  secretions  of  the  mouth. 

Tannin,  Kino,  Rhatany,  and  all  substances  given  above 
that  are  chemically  incompatible  with  Gelatine,  cannot 
be  used  with  the  basis,  Glyco-gelatine. 

The  formula  of  this  latter  is  : 

Gelatinae  Purificatse        .         .  .  .  J  i 

Glycerini  (ab  pondere)            .  .  .  |  iiss 

Liquoris  Carminse  Ammoniatse*  .  ,  q.  s. 

Aquae  Aurantii  Florum  .         .  .  o  J  iiss 

The  process  to  be  followed  in  combining  these  ingre- 
dients will  be  found  in  detail  in  the  Pharmocopoeia  of  the 
Hospital  for  Diseases  of  the  Throat,  London,  1881, 

Four  of  the  most  useful  formulae  of  Dr.  Whistler  are 
here  given.  The  directions  are  for  making  one  pastil  ;  one 
ounce  of  the  mass  will  make  twenty-four. 

*  Pure  carmine  should  be  completely  soluble  in  ammonia. 


66  PHA  RMA  COP  (EI A . 

Pastillus  lodoformi. 

Pulveris  lodoformi  (a  larger  or  smaller 
quantity  according  to  the  indica- 
tions)     .         .         .         .         .         .         gr.  i 

Glycerini       ......  fTii 

Rub  together  and  add  to  the  Glyco-gelatin  (melted  in 
a  water  bath),  gr.  xviii. 

M.     Set  aside  to  cool.     Make  one  pastil. 

Signa. — In  Syphilitic  eruptions  and  ulcerations  of  the  Tongue, 
Mouth,  and  Throat,  and  in  Chronic  Pharyngitis. 

Pastillus  Bismuthi  et  Potassii  Chloratis. 

Bismuthi  Subcarbonatis         .         .         .       gr.  iii 
Potassii  Chloratis  .         .         .         .        gr.  ii 

Glycerini       ......         lUiii 

Rub  together  and  add  to  the  Glyco-gelatin  (melted 
in  a  water  bath),  gr.  xviii. 

M.     Set  aside  to  cool.     Make  one  pastil. 
Signa. — In  acute  and  sub-acute  catarrhal  affections  of  the  Pharynx 
and  Larynx,  and  in  Tonsilitis,  Simple  and  Follicular, 

Pastillus  Bismuthi  et  Morphinae. 

Bismuthi  Subcarbonatis  .         .         •       gr.  iii 

Morphinse  Acetatis        .         .         .         •      gr.  -^-q 
Glycerini        ......         TTj^iii 

Rub  together  and  add  to  the  Glyco-gelatin  (melted 
in  a  water  bath),  gr.  xviii. 

M.     Set  aside  to  cool.     Make  one  pastil. 

Signa. — In  acute  and  sub-acute  catarrh  of  the  Pharynx  and 
Larynx,  in  Tonsillitis,  and  especially  as  a  sedative  in  Laryngeal 
Phthisis. 


TROCHisci.  by 

Pastillus  Acidi  Boraci. 

Pulveris  Acidi  Boraci    .         .         .         .        gr.  ii 
Glycerini        ......  fTlii 

Rub    together  and  add  to  the  Glyco-gelatin    (melted 
in  a  water  bath),  gr.  xviii. 

M.     Set  aside  to  cool.     Make  one  pastil. 

Signa. — In  aphthous  affections  of  the  Mouth  and  Throat. 

Further  formulae,  viz.  : 

Pastillus  Acidi  Carbolici, 
Pastillus  Ammonii  Chloridi, 
Pastillus  Bismuthi 

will  be  found  in  the  Pharmacopoeia  alluded  to  above. 


XL 


CAUSTICA— CAUSTICS. 

Argenti  Nitras  Fusus,  U.  S. 
Acidum  Chromicum. 
Acidum  Nitricum. 
Acidum  Aceticum  Glaciale. 
Caustica  Zinci  lodali. 

Potassii  lodidi    .......     gr.  240 

lodi  ........     gr.  480 

Aquoe  Destillatae         .         .         .         .         .         .  3  iii 

Dissolve  by  trituration  in  a  glass  mortar.     Add  the  above  drop  by 
drop  to  the  following  solution  : 

Zinci  Sulphatis  ......     gr.  200 

Aquse  Destillatse  ......        TI|,i40 

Dissolve.     Allow  to  stand  for  six  hours,  then  decant  liquid  from 

sediment.     Keep  in  a  well-stoppered  bottle. 

Caustica  Zinci  Chloridi. 

Zinci  Chloridi, 

Farinas  Tritici — of  each  equal  parts. 

Reduce  the  Chloride  of  Zinc  to  a  fine  powder  ;  add  the  flour  and 

rub  together  until  they  form  a  mass  ;  dry  until  the  mass  becomes  of 

proper  consistence  ;  then  cut  iuto  strips  ;  roll  into  cylinders  of  the 

required  size,  and  keep  at  a  moderate  temperature  until  dry,  re-rolling 

them  from  time  to  time  if  necessary.     The  little  cylinders  must  be 

kept  in  a  horizontal  position  in  a  well-closed  bottle  until  used. 

Pasta  Londinensis. 

68 


CAUSTIC  A.  69 

Socte  (U.  S.  P.), 

Calcis  (U.  S.  P.) — of  each  equal  parts. 

Reduce  to  a  fine  powder  in   a  warm  mortar  and  mix  intimately. 

Keep  in  well-closed  bottles,  and  when  required  for  use  take  as  much 

as  sufficient  and  make  into  a  paste  with  water. 

Actual  Cautery. 
Galvano-Cautery. 

Caustics  are  of  importance  in  the  treatment  of  many 
diseases  of  the  throat,  and  specially  of  those  of  the  nasal 
passages.  The  most  reliable  of  the  destructive  agents, 
and  therefore  those  commonly  employed,  will  be  found 
in  the  above  list. 

Upon  both  the  nature  of  the  case  and  the  locality  of 
the  parts  to  be  destroyed  will  depend  the  choice  of  the 
particular  form  of  caustic,  the  latter  varies  also,  accord- 
ing to  the  views  of  the  particular  operator  who  uses  it. 

Larynx. 

In  the  Larynx,  caustic  applications,  for  the  purpose  of 
destroying  neoplasms  of  various  nature,  are  by  no  means 
as  frequently  employed  as  formerly  ;  the  laryngeal  for- 
ceps in  some  one  of  its  varieties,  or  some  other  mechan- 
ical device  for  their  removal,  having  justly  superseded 
them.  Some  operators  still  advise  the  use  of  the  Gal- 
va?io-catitery,  beyond  question  the  best  method,  should 
the  caustic  treatment  be  adopted,  and  one  very  properly 
employed  in  some  cases  for  the  purpose  of  destroying  the 
base  and  site  of  a  laryngeal  growth  to  prevent  its  repro- 
duction, the  greater  part  or  all  of  which  has  been 
previously  removed  by  means  of  the  forceps  or  hraseur. 


Fig.  22. — Galvano-cautery  instruments 
for  use  in  the  larynx. 

70 


CAUSTICA.  71 

The  destruction  of  the  base  of  a  laryngeal  growth,  after 
its  removal  by  forceps  or  otherwise,  may  be  likewise  ac- 
complished by  tlie  use  of  Argenti  Nitras  or  the  Aciduni 
Chromicum^  either  salt  being  carried  into  the  larynx  and 
to  the  desired  point  by  means  of  a  delicate  probe,  under 
the  guidance  afforded  by  the  laryngoscopic  mirror. 

Pharynx. 

Chronic  Follicular  Pharyngitis  is  most  satisfactorily 
treated  by  the  destruction  of  the  individual  follicles  and 
their  nutrient  vessels.  Here  again  the  fine  Galvano- cautery 
point,  carried  deeply  into  each  hypertrophied  follicle  until 
its  base  is  reached,  forms  the  most  efficient  means.  The 
Actual  cautery  is  recommended  by  some,  and  still  another 
method  lies  in  an  incision  into  each  hypertrophied  fol- 
licle (a  i^"^  only  being  treated  at  each  sitting)  by  means 
of  a  small  tenotomy  knife,  and  the  immediate  subsequent 
application  to  each,  of  the  Caustica  Zinci  lodati,  Zinci 
Chlo7'idi,  or  of  Acidimi  Chromicum,  to  ensure  their  de- 
struction. 

Secondary  Syphilitic  Lesions  of  the  Mouth,  Tonsils, 
and  Pharynx  (mucous  patches  and  superficial  ulcerations) 
may  be  lightly  touched  from  time  to  time  with  Argenti 
Nitras  until  they  disappear. 

Tertiary  Syphilitic  Ulcerations  of  the  throat  require  the 
same  treatment  until  each  individual  ulcer  has  assumed 
a  healthy  aspect  and  presents  a  clean  granulating  base. 
From  this  stage  onward  they  are  best  treated  by  the 
application  of  iodoform  in  fine  powder. 

It  may  not  be  inappropriate  at  this  point  to  call  atten- 


^2 


PHARMA  COP  (EI A . 


tion  to  the  danger,  realized  in  more  than  one  instance 
upon  record,  of  the  ordinary  crayon  of  nitrate  of  silver 
breaking  and  falling  into  the  air-passages,  when  used  in  the 
throat  in  an  ordinary  quill  or  common  caustic  holder.  The 
porte  caustique  shown  in  the  cut  will  reduce  this  danger 
to  a  minimum,  but  it  may  readily  be  rendered  impossible, 


Fig.  23. — Porte  caustique. 

by  fusing  a  small  rounded  button  of  the  silver  salt  upon 
the  end  of  an  aluminium  or  silver  probe,  a  few  crystals 
having  been  melted  in  a  small  porcelain  crucible  over  a 
gas  flame,  and  the  end  of  the  probe  having  been  dipped 
once  or  twice  into  the  melted  mass  and  then  cooled. 


Fig.  24. — Silver-tipped  probe,  for  caustic. 


Fig.  25. — Porcelain  crucible  for  smelting  nitrate  of  silver. 

After  the  use  of  nitrate  of  silver  in  the  throat,  the  pa- 
tient should  at  once  gargle  with  a  weak  solution  of  chloride 
of  sodium  in  water  ;  all  further  corrosive  action  of  the 


CAUsricA.  73 

drug  is  thus  prevented,  an  inert  chloride  of  silver  being 
formed  with  the  excess  of  the  silver  salt. 

In  using  this  caustic,  as  well  as  all  of  the  other  forms, 
the  more  powerful  ones  specially,  a  dextrous  and  steady 
hand  is  required,  in  order  that  the  application  may  be 
made  thoroughly  yet  carefully,  accurately  and  neatly,  to 
the  affected  point  alone. 

Tonsils. 

The  destruction  of  Hypertrophied  Tonsillar  Tissue 
demands  the  employment  of  the  more  active  caustics. 
Aside  from  the  Galvano- cautery,  the  Caustica  Zinci  lodati 
and  the  Pasta  Londmensis  are  used,  being  applied  in 
small  quantities  by  means  of  a  glass  rod,  at  suitable  inter- 
vals. Any  such  method  of  treatment,  however,  is  neces- 
sarily prolonged  and  unnecessarily  cruel  to  the  patient,  as 
well  as  in  its  ultimate  results,  far  inferior  to  those  gained 
by  the  excision  of  the  hypertrophied  gland  by  means  of 
the  tonsillitome. 


Fig.  26 — Tonsillitome. 


74 


PHA  RMA  COP  (EI A . 


Nasal  Passages. 


The  Rhino-surgery  of  the  day  relies  largely  upon  the 
use  of  caustics,  as  a  means  of  destroying  the  redundant 
tissue,  in  cases  of  Hypertrophic  Nasal  Catarrh,  and  in 
hypertrophy  of  the  adenoid  tissue   at  the   vault  of  the 

pharynx, — ''  Adenoid  Vegetations." 


Fig.  27. — Galvano-cautery  instruments  for  use  in  the  nasal  passages. 


The  Galvatio-cautery,  if  used  for  the  above  purpose,  is 
unquestionably  a  radical  and  efficient  agent,  and  has  its 
warm  advocates  ;  but  instances  where  its  use  is  a  neces- 
sity are  not  very  many,  and  I  believe  that  we  may  often 
accomplish  the  same  results  as  it  attains  with  less  heroic 
means.     I  allude  here  to   its  employment  in  the  morbid 


CAUSTICA.  75 

conditions  of  both  nasal  passages  and  vault  of  the  phar- 
ynx. In  the  former  locality  the  agents  employed  are,  in 
my  experience,  as  to  order  of  merit,  Acidum  Nitricum^ 
Acidiiin  Aceticu7ji  Glaciale^  Acidum  C/iromicum,  and  Argen- 
ti  Nitras.     The  operation  is  as  follows  : 

In  Hypertrophic  Rhinitis,  where  the  hypertrophied 
mucous  membrane  is  found  to  be  located  mainly  over  the 
inferior  turbinated  bone,  in  one  or  both  nasal  passages, 
and  where  there  is  partial,  intermittent,  or  permanent 
occlusion  occasioned  by  its  presence,  take  a  small 
probe,  its  end  wrapped  in  absorbent  cotton,  and  saturate 


Fig.  28. — Hard-rubber  probes. 


this  with  nitric  acid,  press  out  the  excess  of  acid,  pass  it 
then  through  a  suitable  nasal  speculum  into  the  naris  to 
be  operated  upon  under  the  guidance  of  a  good  reflected 
light  from  the  forehead  mirror,  and  with  a  steady  hand, 
draw  it  along,  or  press  it  firmly  upon,  the  turbinated  bone 
at  its  point  of  greatest  convexity,  contact  being  kept  up 
for  a  few  seconds.  The  pain  quickly  passes  away,  and 
on  withdrawing  the  probe  the  parts  are  seen  to  have 
become  well  whitened  or  blanched  ;  moderate  inflamma- 
tory reaction  with  a  slough  of  varying  depth  follows, 
while  the  consolidation  of  the  sub-mucous  tissues  by  the 
hyperplastic  results  of  the  inflammatory  process,  and  the 
Qontraction  of  the  cicatricial  tissue  occupying  the  site  of 


76  PHARMACOPCEIA. 

the  destroyed  parts,  serve  to  reduce  the  hypertrophy  and 
its  resultant  nasal  obstruction  in  a  most  satisfactory 
manner.  Frequently,  one  application  answers  all  purpo- 
ses in  freeing  the  nasal  passage  to  the  extent  of  allowing 
of  uninterrupted  respiration.  The  process,  however, 
may  require  repetition. 

The  operation  with  glacial  acetic  acid  is  performed  in 
the  same  manner  ;  it  is  less  painful,  causes  little  secondary 
inflammation,  and  destroys  less  tissue.  This  agent,  then, 
may  be  selected  for  the  more  moderate  and  more  recent 
cases  of  hypertrophy. 

Chromic  acid  is  less  painful  in  its  use  than  nitric ;  its 
fumes,  though,  are  distressing  to  the  patient.  It  pos- 
sesses no  advantage  over  the  other  two. 

Nitrate  of  silver,  as  a  destructive  agent,  I  mention  but 
to  condemn.  It  causes  but  a  superficial  slough,  and  the 
application  is  of  necessity  frequently  repeated  in  treating 
hypertrophied  tissue  of  any  extent ;  moreover,  owing  to 
its  powerfully  stimulating  qualities,  it  excites  cell  prolif- 
eration, and  causes  structural  changes  that  are  not 
desirable. 

After  the  use  of  any  form  of  caustic  in  the  nasal  passa- 
ges, immediately  upon  the  withdrawal  of  the  probe,  the 
parts  should  be  flooded  with  an  alkaline  solution.  The 
subsequent  treatment  of  the  case,  at  least  until  the  slough 
has  separated  and  the  resultant  ulcer  healed,  is  based 
upon  ordinary  principles  of  cleanliness. 

In  cases  where  the  hypertrophy  of  the  tissues  is  ex- 
treme, and  is  mainly  limited  to  the  posterior  extremities 
of  the  inferior  turbinated  bones,  a  locality  inaccessible 
to  the  use  of  caustics,  the  procedure  devised  by  Jarvis, 


CAUSTIC  A.  yy 

for  its  removal  with  the  wire  ecraseur,  must  be  under- 
taken. In  cases  also  in  which  the  hypertrophied  tissue 
is  located,  in  marked  degree,  over  the  anterior  extremi- 
ties of  the  inferior  turbinated  bones,  the  operation  of 
Jarvis  is  preferable  to  the  use  of  caustic.  (See  Lefferts 
"  Chronic  Nasal  Catarrh,"  Philadelphia  Medical  JVews, 
April  26,  May  3,  1884). 

Vault  of  the  Pharynx. 

In  the  treatment  of  hypertrophy  of  the  Adenoid  Tissue 
at  the  Vault  of  the  Pharynx,  mineral  caustics,  viz., 
Acidum  Chromicum  and  Argeiiti  JVitras  Fusus  have  justly 
been  superseded  in,  I  believe,  the  majority  of  hands,  by 
the  use  of  instruments.  A  pair  of  long  forceps,  suitably 
curved,  to  be  passed  behind  the  velum,  and  furnished 
with  cutting  blades  at  their  extremity  (Woakes'  forceps, 
modified  by  Semon),  will  be  found  to  be  the  best  means. 


Fig.  29. — Post-nasal  forceps. 

Except  when  the  hypertrophy  of  the  tissues  extends 
broadly,  in  the  shape  of  small,  slightly  elevated,  nodular 
masses,  over  the  entire  pharyngeal  vault,  when  a  sharp 
curette  such  as  is  used  in  uterine  operations,  but  suitably 


7  8  PHA  RMA  COP  (EI A . 

curved  to  pass  behind  the  velum  into  the  upper  pharynx- 
will  answer  a  better  purpose  in  scraping  away  the  vegeta- 
tions than  the  forceps,  which  would  here  be  difficult  of 
exact  application. 


Fig.  30. — Post-nasal  curette. 


XII. 
VARIiE-MISCELLANEOUS. 

"  Anti-Catarrhal  Smelling  Salts." 

5  No.  I 

Acidi  Carbolici     .....  3  i 

Carbonis  Ligni      .....  |  ss 

lodi       .         .         .         .         .         .         .  3i 

Mix  the  carbolic  acid  with  one  half  of  the  charcoal, 
mix  the  iodine  with  the  other,  then  mix  together  thor- 
oughly. 

^  No.  2 

Ammonii  Carbonatis     .         .         .         .  §  i 

Carbonis  Ligni      .....  |  ss 

Camphorae    ......  |  i 

M.  Add  No.  I  and  No.  2  together  lightly,  then  add 
Olei  Lavandulae,  gtt.  xx.,  and  sufficient  quantity  of  Tinc- 
turae  Benzoini  Compositse  to  make  a  thick  paste  ;  keep 
in  a  wide-mouthed,  glass-stoppered  bottle,  from  which 
inhalations  through  the  nose  are  made  from  time  to  time. 

Use. — Recommended  for  acute  coryza. 

79 


8o 


PHARMA  COPCEIA. 


Fig.  31. — Pocket  inhaler. 

Hager-Brand's  Remedy  for  Acute  Coryza. 


Acidi  Carbolic! 

Alcoholis 

Aquse  Ammonise  Fortioris 

Aquae  Destillatae  . 


31 

3  iii 

3i 

3ii 


M.  A  few  drops  of  this  solution  are  to  be  sprinkled 
on  the  handkerchief,  or,  more  conveniently,  some  of  the 
solution  is  placed  on  the  sponge  of  the  pocket  inhaler, 
and  inhaled  through  the  nose  as  long  as  its  strength  lasts  ; 
this  is  to  be  repeated  every  two  or  three  hours. 


Snuff  for  Chronic  Coryza. 


5 


Hydrastis  Canadensis    . 

gr.  V 

Indigo            .... 

gr.  ss 

Pulveris  Camphorse 

gr.  ii 

Acidi  Carbolici     . 

gr.  ii 

Sodii  Chloridi 

3i 

M. 


Oleatum  Hydrargyri. 


^ 


Hydrargyri  Oxidi  Flavi 
Acidi  Oleici 


3i 
3  ix 


M. 


Use. — For  promoting  absorption  in  cases  of  Fibrous  Goitre,  and 
specially  of  Indurated  Cervical  Glands. 


VARIM.  8 1 

Oleatum  Hydrargyri  cum  Morphina. 

Morphinae  (pure  alkaloid)     .         .         .  gr.  x 

Acidi  Oleici 3  v 

Dissolve  and  add 

Oleati  Hydrargyri  (lo  ^)       .         .         .  3v 

M. 

Use. — Same  as  above  ;    in  cases  where  the   simple  oleate  causes 
much  pain. 

Unguentum  lodinii  Compositum,  U.  S.  P.,  1870. 
Use. — Same  as  above. 


APPENDIX. 

Air-Compressing  Apparatus.* 

A  number  of  different  forms  of  hand-pump  apparatus 
are  procurable  for  the  purpose  of  obtaining  a  given  de- 
gree of  air-pressure  in  the  cylinder  or  reservoir,  which  is 
connected  with  them  by  means  of  "  hydraulic  "  rubber 
tubing,  and  in  turn  with  the  glass,  rubber,  or  metal  spray- 
tubes  by  rubber  tubing  of  small  calibre,  which  should  be 
overspun  with  silk  or  mohair,  in  order  that  it  may  possess 
strength  combined  with  flexibility  (see  fig.  6),  and  is 
firmly  secured  to  the  connecting  fittings  by  plated  metal 
collars.  The  cylinder,  or  condensed  air-receiver,  should 
be  wrought  of  copper — riveted  sheet-brass  receivers  sel- 
dom remaining  air-tight  for  any  length  of  time — is  bur- 
nished to  a  high  degree  of  finish,  and  usually  nickel-plated. 
Its  stop-cocks — of  which  there  should  be  but  two,  one  of 
entrance  and  one  of  exit  for  the  compressed  air — must  be 
well  and  carefully  ground,  in  order  to  be  perfectly  air- 
tight. A  gauge  for  registering  the  amount  of  air-pressure 
is  a  very  useful  adjunct  to  any  form  of  air-receiver. 

*  The  necessity  for  such  information  as  is  furnished  in  the  Appen- 
dix has  been  suggested  to  me  by  repeated  inquiries  concerning  the 
practical  points  therein  alluded  to,  on  the  part  of  my  students. 

82 


APPENDIX. 


83 


Fig.  32. — Condensed-air  receiver. 

A  more  modern  device  has  substituted  for  the  two 
stop-cocks  shown  above  ;  one^  which  consists  of  a  rod, 
conic  at  one  extremity,  supplied  with  a  screw,  thread,  and 
a  wheel  for  readily  propelling  it  outward  or  for  gently 
screwing  the  conic  end  of  the  rod  perfectly  air-tight  into 
a  compartment  containing  soft  metal,  thus  (when  the  ap- 
paratus is  not  in  use)  relieving  of  pressure  the  stop-cocks 
of  entrance  and  exit  of  the  compressed  air,  and  thus  pre- 
venting the  escape  of  air  through  them,  when  worn  by 
active  use  (see  fig.  6). 

This  receiver  is  made  of  the  following  dimensions  : 
io-|-  inches  by  7  J  inches,  and  its  advantage  over  the  older 
forms  lies  in  the  reduction  in  size  and  in  the  arrangement 
of  the  stop-cocks,  which  reduces  the  escape  of  the  com- 
pressed air  from  the  cylinder,  either  when  in  or  out  of 
use,  to  a  minimum. 

The  forms  of  hand  air-compressors  that  are  known  to 
me  are  as  follows  : 


84  PHARMA  COFCEIA . 

I.    The  Burgess  Double-Acting  Air-Compressor, 

in  which  the  construction  is  simple  and  manner  of 
working  easy  and  effectual,  as  a  pressure  of  fifty  pounds 
to  the  square  inch  can  be  obtained  with  but  little  effort. 
The  person  working  the  pump  stands  in  an  upright  posi- 
tion, and  can  throw  his  weight  against  the  lever  without 
bending  the  body  or  using  violent  exertion  (as  with  the 
lift  or  crank  motion).  The  pump  being  double-acting, 
forcing  air  at  each  stroke,  no  power  is  lost  in  its  manipu- 
lation. The  pump  is  made  of  iron,  having  two  cylinders 
cast  in  one  piece,  each  three  inches  in  diameter.  The 
piston  heads  are  connected  together  and  operated  by  a 
lever^  which  can  be  removed  from  the  socket,  allowing 
the  pump  to  occupy  but  little  space,  /.  ^.,  12  inches  in 
length,  9  inches  high,  7  inches  wide — weight  25  pounds. 
The  valves  are  carefully  adjusted,  and  seat  themselves 
readily.  The  packing  rings  are  of  leather,  and  can  be 
lubricated  by  removing  the  two  screws  on  top  of  the 
cylinder. 

II.    The  Burgess  Air-Compressor. 

In  this  apparatus  the  pump  cylinder  is  made  of  iron, 
and  mounted  on  an  arched  stand,  and  contains  a  piston 
having  a  valve  opening  upward.  The  piston  is  connected 
by  a  forked  connecting-rod,  and  is  moved  by  a  slight  and 
easy  motion  of  the  foot.  The  upper  end  of  the  pump 
cylinder  is  closed,  with  the  exception  of  a  valve  aperture 
opening  into  a  small  or  sub  air-chamber,  which  is  secure- 
ly attached  to  a  large  air-reservoir,  made  of  heavy  char- 
coal tin,  measuring  9  inches  in  diameter,  and  14  inches 


APPENDIX.  85 

high.  Connection  is  made  between  the  sub  air-cham- 
ber and  the  reservoir  by  a  small  brass  tube,  the  air 
being  admitted  or  confined  by  a  stop-cock.  Near  the  top 
of  the  reservoir  there  is  a  second  stop-cock,  to  which  is 
attached  a  flexible  rubber  tube  leading  to  the  spray-tube. 
In  the  upper  end,  near  the  edge  of  the  reservoir,  is 
secured  a  small  pressure  gauge,  indicating  the  pressure  to 
the  square  inch  of  the  air  contained  in  the  apparatus — 
from  one  to  twenty  pounds, 

III.    Wile's  Spray  Apparatus. 

The  pump  of  this  apparatus  is  attached  to  a  bracket 
with  an  oscillating  piston  and  lever,  and  can  be  pumped 
to  a  hundred  pounds  pressure  to  the  square  inch.  When 
the  gauge  indicates  one  pound  pressure,  every  full  stroke 
of  the  piston  increases  the  pressure  one  pound. 

IV.     The  Novelty  Air-Pump  (Besseler) 

is  capable  of  compressing  one  hundred  pounds  to  the 
square  inch  ;  in  two  minutes  will  give  fifty  pounds  pres- 
sure in  an  ordinary  receiver. 

V.  The  small  hand-pump  which  is  usually  furnished 
by  the  instrument  maker,  in  connection  with  the  complete 
"  Compressed-air  apparatus  "  (fig.  6),  I  cannot  recom- 
mend. (It  is  made  of  brass  and  has  valves  which  prevent 
the  return  of  the  air  from  the  receiver,  and  through  the 
pump,  whilst  working  the  latter.)  Its  disadvantage  lies  in 
the  fact  that  it  must  be  held  upon  the  floor  by  the  feet  of 


86  PHARMA  COPCEIA . 

the  operator,  or  even  if  secured  by  screws  to  the  former, 
the  position  of  the  operator  who  is  using  it  is  both  incon- 
venient and  laborious.  Moreover,  a  low  degree  of  air- 
pressure  only  can  be  obtained  by  its  means. 

VI.    Weindel's  Double-Acting  Air-Compressors. 

The  forms  of  air-compressors  that  I  have  used  con- 
stantly and  satisfactorily  for  a  number  of  years  are 
shown  in  the  following  wood-cuts,  and  I  regard  them  as 
superior  in  their  working  qualities  to  any  other  form  of 
hand-apparatus,  for  the  purpose  of  compressing  air,  with 
which  I  am  acquainted.  They  are  manufactured  by 
Weindel,  of  Philadelphia. 


8; 


Fig.  33. — "  Acme  "  double-acting  air-compressor. 
Base-Board,  13  x  9  in.      Height,  24  in.     Fly-Wheels,  12  in.     Cylin- 
der, 2  X  4  in.  stroke.     Weight,  34  pounds. 

A  pressure  of  30  lbs.  and  higher,  can  be  reached  in  a 
large  receiver  in  little  more  than  a  minute,  as  the  regular 
speed  is  about  160  revolutions  per  minute. 


88 


Fig.  34.—"  Reliance  "  double-acting  air-compressor. 

Wheels,    iS   in.     Cylinders,  2f^  and   i{\  ^  Sh    i^.    stroke.     AVeight 

126  lbs. 


APPENDIX.  89 

This  pump  is  designed  for  120  lbs.  pressure — gives 
therefore  50  to  60  lbs.  with  the  greatest  ease  in  the 
ordinary-sized  receiver  (a  receiver  of  the  size  shown  in 
the  wood-cut  is  never  necessary  for  the  purpose  of  the 
physician). 


INDEX. 


Acetic  acid  in  hypertrophic  rhinitis 

76 

Actual  cautery         .... 

69 

Adenoid  vegetations 

74 

Air-compressing  apparatus 

82 

"Acme" 

87 

"Reliance" 

88 

Weindel's 

86 

Air-compressor,  Burgess 

84 

Air  passages,  Benzoic  acid  in  affections  ( 

3f 

44 

Air  pump,  Besseler's  "  Novelty  "    . 

85 

Air-receiver    .         .         .         .         . 

83 

Ammonia  in  inhalations 

46 

Amyl  nitrite,  vapor  of    . 

50 

Anaesthetics             .... 

"             Camphorated  Chloral  . 

"              Linimentum  Aconiti    . 

"              Linimentum  Belladonnse 

"              Linimentum  Chloroformi 

"              Unguentum  Aconitiae 

Anterior  nasal  syringe     . 

9.  24 

Anti-catarrhal  smelling  salts 

79 

Anti-diphtheritic  spray    . 

22 

Antiseptic  spray 

22 

Antiseptic  troches 

63,  64 

Aphonia,  Ammonia  in 

46 

Aphthous  affections 

67 

Aquae  Medicatae 

12 

"      Anti-diphtheritic 

22 

"     Antiseptic    . 

22 

91 


92 


PHA  RMA  COP  (EI A . 


Aquas  Astringent    . 
"      Sedative 
"      Stimulant 

Directions  for  use 
Asthma,  nitrite  of  amyl 
Astringent  spray     . 
Astringent  troches  . 
Atomized  fluid  inhalations 
Atomizer  (hand),  Bergson's 

Codman  and  Shurtleff 
"  "        Davidson's  . 

"  "        Richardson's 

"  "        Directions  for  use 

Automatic  cut-off    . 

Bismuthi  Oxychloridum 
Bronchial  tubes,  Spasm  of 
Buginaria        .... 
"        Directions  for  use  , 

Camphorated  Chloral 
Carcinomatous  ulceration  of  throat 
Catarrh,  Atrophic  ... 
Fetid 

"        Hypertrophic    . 

"        Nasal,  chronic 
Caustica  .... 

"         Argenti  Nitras  Fusus 

"         Acidum  Chromicum 

"         Acidum  Nitricum 

"  Acidum  Aceticum  Glaciale 

"         Caustica  Ziuci  lodati 

' '         Caustica  Zinci  Chloridi 

"         Actual  Cautery 

"         Galvano-cautery 

"         Pasta  Londinensis 

"         Directions  for  use 


21 

22 

21 

12, 

14,  22 
50 
21 

62,  63 

51,  54 
17 
17 

17,  18 

17 

19,  20 

16 

31 

55 
36,  37 
36,  38 

I 
51 

23, 

32,  38 

23, 

32,  38 

23, 

32,  38 

23, 

32.  38 
68 

68, 

71, 

75,  77 

68, 

71 

75,77 
68,75 
68,75 

• 

68 

71,  73 

68,  71 

69,  71 

69, 

71 

73,  74 

68,  73 

69,  78 

INDEX. 


93 


Caustics  ..... 

"         Directions  for  use     . 
Ceratum  Cantharidis 
Charta  Cantharidis 
Chromic  acid  in  hypertrophic  rhinitis 
Chromic  acid  in  hypertrophic  pharyngitis 
Collunaria       .... 
"         Directions  for  use  . 
"         Alkaline 

"         Carbolic  acid  and  borax 
"         Chloride  of  sodium 
"         Listerine 

"         Permanganate  of  potassium 
"         Salicylate  of  sodium 
Collyria 

"      Alterative  . 
"      Antiseptic  . 
"       Astringent 
"       Stimulant  . 
"       Directions  for  use 
Compressed-air  spray  apparatus 
Condensed-air  receiver    . 
Condy's  fluid 
Coryza,  Acute 

"       Hager-Brand's  remedy  for 
Cotton-wools,  Medicated 
Borated 
"       Carbolated 
"       Haemostatic 
"       Iodized 
"       Iodoform    . 
"      Salicylated 
"       Styptic 
"       Tannated  . 
Counter-irritants     . 

' '  Ceratum  Cantharidis 

"  Charta  Cantharidis 


68 

69,  78 

I 

I 

76 

77 

3 

5,  4,  10 

9 
10 

II 
10 
II 
II 

25 
28 
28 
26 
27 
26 
14,  15 
83 
II 

33.  79 
80 

39 

39 

39 

39 

39 

39 

39 

39 

39 

I 

I 

I 


94 


PHARMA  COP  (EI A. 


Counter-irritants  Linimentum  Cantharidis 
'*  "  lodi 

"  Tinctura  lodi 

*•  "       lodini  Composita 

Croup-kettle  . 

Crucible  for  nitrate  of  silver 

Diphtheria 
Dobell's  solution     . 

Expectorant  troches 

Fauces,  Acute  diseases  of 

"        Affections  of  anterior 
Ferrier's  snufF 

Fibrous  goitre,  Absorption  of 
Fumi      .... 
Fuming  inhalations 

"  "  directions  for  use 


Galvano-cautery  instruments 
Gargarismse    . 
Gargles  .... 
"       Antiseptic  . 
' '       Astringent 
' '       Rules  for  the  use  of 
"       Sedative 
Glands,  indurated  cervical 
Glottis,  spasm  of    . 
Glycerita 

Glyceritum  Acidi  Carbolici 
"  Acidi  Gallic! 

*'  Acidi  Tannici 

' '  Amyli 

Sodii  Boratis 
Goitre,  Fibrous 
Gossypia 


I 

I 

I 

I 

42 

72 

22,  53 
II 

63 

56 

57 
33 
80 

55 
55 
55 

70,  74 

56 

56 

59 

57 

56 

60 

80 

50 

28 

28,  60 

28,  60 

28,  60 

28 

28,  60 

80 

39 


INDEX. 


95 


Haemoptysis 

Hemorrhage  from  amputated  tonsils 

Inhalation  es  .         .         .         • 
Inhalations     .... 
' '  Atomized  fluid 

"  Fuming 

"  Steam    . 

**  Directions  for  use 

Inhalers,  Eclectic  . 
"  Hospital 
•'  Pocket  . 
"  Mackenzie's  . 
"  Maw's  . 
Portable  . 
Insufflations  into  larynx 

"  "     nasal  passages 

Insufflator  for  larynx 

••  "   anterior  nares  . 

•'  "   posterior  nares 

Insufflations — directions  for  use 
Jarvis'  operation     . 

Kaolin,  Prepared,  in  inhalations 

Laryngeal  spray     . 

Laryngorrhcea,  Vapor  cubebae  in 

Laryngoscopic  mirror 

Larynx,  Applications  to,  Anti-diphtherit 
"  •'  "    Antiseptic 

♦•  •'  "    Astringent 

««  '•  "    Brush  for 

•'  "  "    Caustic     . 

«'  "  "    Local 

««  "  "    Sedative  . 

"  "  "    Spray 

•*  "  "    Stimulant 


42. 


53 
59 

40 
40 

54 

55 
40 

52,  55 
41 
41 
80 

41 
42 

41 
29 
29 
30 

32 

33 

29,  32 

77 

44 


13 

45 

16,  26 

22 

21,  28 
26,  30 

25 
69 
28 

22,  30 

13,  19 

21,  27,  28 


13 


96 


PHA  RMA  COP  (EI A . 


Larynx,  Cleansing  of 
"        Congestion  of  . 
* '        Hemorrhage  from 
'*        Hypersesthesia  of 
"        Inflammation  of ,  Acute 
"  "  "   Chronic 

"  Glandular 
"  Subacute 
"         Irritation  of 
"         Insufflations  into 
"         Phthisis  of 
"        Spasmodic  affections  of 
"  "  contraction  of 

"        Syphilis  of 
Linimentum  Aconiti 

* '  Belladonnse 

"  Cantharidis 

"  Chloroformi 

lodi   . 

Listerine         .... 

Lozenges        .... 

Medicated  waters  . 
Medicated  cotton-wools 
*'  sprays  . 


Nasal  bougies 

Rules  for  use 

catarrh  .         .         . 

douche 

passages        . 

Chronic  inflammation  of 
Cleansing  of    . 
Medicated  powders  for 
Spray  applications  to 
Caustic 
Ointments  for 


5.  29 
25 


3,  29 
49 


6,  10 


13 


3 

47 
53 

I 
29,  40 
40,  48 

47 
29,  40 

59 

29,  35 

49,  66 

50,55 

12 

29 


23, 

60 

61 

12 

39 

12 

36 

36 

38, 

74 

4,  5 

4 

5 

4 

32, 

35 

20, 

22 

74 

2 

INDEX. 

97 

Nasal  spray  apparatus    ........           6 

"          "            "           Directions  for  using     , 

7,8 

"      syringe,  Anterior           .... 

9. 24 

•'           "         Posterior 

8,24 

"      tube,  Posterior,  with  syringe 

9 

Nebulas           ....... 

51 

"      Rules  for  use       ..... 

52 

Neoplasms,  Removal  of          ... 

69 

Oil  of  lemon  in  inhalations     . 

46 

"      pine  leaves  in  inhalations 

48 

Oleatum  Hydrargyri       .... 

80 

"                "           cum  Morphina 

81 

Ozsena,  Strumous    ..... 

38 

Syphilitic            .... 

38 

Pasta  Londinensis          .... 

68 

Pastils -    . 

61 

"       Whistler's    .         .         . 

.        65 

Pastillus  Acidi  Boraci      .... 

67 

"        Acidi  Carbolici          .... 

67 

*'        Ammonii  Chloridi 

67 

Bismuthi            .... 

67 

"        Bismuthi  et  Morphinse 

66 

"        Bismuthi  et  Potassii  Chloratis  . 

66 

**        lodoformi          .... 

66 

Petrolati 

2 

Pharynx,  applications  to.  Anti-diphtheritic 

22 

"                  "             "    Antiseptic 

.  21,  28 

*'                  "             "    Astringent 

21,  26 

"    Brush  for 

25 

*'             "    Caustic   . 

71,  77 

"             "    Sedative 

22 

"    Spray      . 

I 

3,  19,  22,  23 

"    Stimulant 

21,  27,  28 

"         Hypertrophy  of  vault  of  . 

77 

*'        inflammation  of.  Acute    . 

40 

48,  62 

98 


PHA  RMA  COP  (EI A . 


Pharynx,  inflammation  of,  Chronic 
"    Follicular 
"    Subacute 
Pigmenta,  External 
"  Internal 

Pocket  inhaler 
Porte  caustique 
Powder  insufflators 
Powders 

' '        Directions  for  using 
' '        Astringent 
' '        for  nasal  passages 
"         for  larynx 
*'        Sedative   . 
Posterior  nasal  syringe    . 
Post-nasal  curette   . 
"         forceps  . 
tube 
Probe  for  caustic    . 
"      Hard-rubber 
Pulveres 

"        Directions  for  using 

Rhinitis,  Atrophic 
Fetid 
"  Hypertrophic  . 

"  Simple  chronic 

Sedative  troches 

Sialogogue  troches 

Silver  nitrate,  Danger  in  use  of 

"  "        in  tonsillar  hypertrophy 

Smelling  salts 
Snuff,  Ferrier's 

"      for  acute  coryza    . 
Solutions,  Cleansing  and  disinfecting 
Spasm  of  the  glottis 


26 

71 

26,  40 

I 

2 

80 

72 

30,  32,  33 

29 

29,  32 

30 

33,  34,  35 

30,  31,  35 

30 

8 

.    .    78 

77 

9 

72 

75 

29 

29,  32 

23,  32,  38 

23,  32,  38 

5,  23,  32,  75,  38 

2,  5,  23,  32,  38 

.    .    62 

62 

72,  76 

77 

79 

33 

80 

9,  10,  II 

50 

INDEX. 


99 


Spirits  of  camphor  in  inhalations 
Spray  apparatus,  Wile's 

"      applications,  Method  of  employing 
"      tubes    .... 
Sprays,  Medicated 

"      Anti-diphtheritic 
"      Antiseptic 
"      Astringent 
"      Sedative     . 
"      Stimulant  . 
Steam-atomizing  apparatus 

'*  "  Rules  for  the  use 

Steam  inhalations  . 

"  "  Rules  for  the  use  of 

Syphilis,  Tertiary  . 
Syphilitic  lesions  of  mouth 

"       "     tonsils    . 
"         ulceration  of  throat 
Syringe,  Anterior  nasal 
"         Posterior  nasal 

Terebene        .         .         .    -    . 

Thymol  in  inhalations     . 

Tinctura  lodi 

Tinctura  lodinii  Composita  (U.  S.  P.  1870) 

Tonsillitis,  Follicular 

"       Simple 
Tonsillitome 
Tonsils,  Caustic  application  to 

"        Hemorrhage  from  amputation  o 

"        Hypertrophied 

"        inflammation  of,  Acute 

"    Subacute 
Trachea,  Affections  of 

"        Chronic  congestion  of,  vapors  in 
"        Spasmodic  affections  of 
Troches  .... 


of 


40, 


47 

85 

3,  13 

16 

10,  12 
22 
21 

10,  22 
22 
21 

51 
52 
40 
42 

51 
66,71 
66,71 
66,71 

9 

8 

49 

48 

r 

I 

66 

48,  66 
73 
73 
59 
73 

47,  62 
40 
29 
47 
55 
6i 


I OO  PHA  3MA  COP  (EI A . 

Trochisci 6i 

"         Browne's          ........  63 

"         Cooper's           ........  63 

"         MacKenzie's .  62,  63 

••         Wyeths 64 

"         Rules  for  use  of       .......  61 

Unguentum  Acidi  Carbolic!    .......  2 

"             "           "         cum  lodo  et  Atropina     ...         .  2 

"          Aconitiae      ........  2 

"          Belladonnse           .......  2 

"           Hydrargyri  Chloridi  Mitis     .....  2 

"  lodinii  Compositum      .         .         .  .         .         .81 

Valsalvan  Inhalations,  vapor  for      ......  49 

Vapor  Acidi  Benzoici       ........  44 

"       Acidi  Carbolici     ........  51 

"      Acidi  Hydrocyanici      .......  49 

'•      yEtheris .50 

"      Ammoniae 46 

"      Ammonii  Benzoatis       .         .         .    -     .         .         .         .  45 

"      Amyl  Nitritis 50 

"      Benzoini        .         .         .         .         .         .         ...  44 

' '      Calami  Aromatici           .......  47 

"      Camphorae    .........  47 

"      Chloroformi 50 

"      Creasoti 47 

•'      Cubeb^         .         .         .         .        ■ 45 

"      Cubebse  cum  Limone    .......  46 

"      lodi  Benzoinati     .         .         .         .         .         .         .         .  45 

' '      lodi  Camphorati  ........  49 

"      Juniperi  Anglici 46 

"      Myrti 48 

"      Pini  Sylvestris      ........  48 

"      Terebenis      .         .         .         .         .         .         .         .         .49 

"      Thymolis      .........  48 

Vapores  Calidi        .........  40 


INDEX. 


ioi 


Vapores,  Calidi,  Rules  for  Using 
Vapors,  Stimulating 

"        Sedative     . 

"       Anti-Spasmodic 

"        Antiseptic  . 
Variae     ..... 
Voice  stimulants 


46 


42 

45 

49.  50 

50,  51 

51 

79 
61,  62 


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